16 year old male, jumping from bridge, slipped and struck head on railing before hitting the water.
16 year old male, jumping from bridge, slipped and struck head on railing before hitting the water.
Came up above water, but appears dazed and slow to respond to questions.
His mother brings him to the local emergency department.
On your initial assessment, he is amnestic to the events surrounding his injury, oriented to person, place and time, and is complaining that “the back of my head hurts”. The rest of his exam is unremarkable.
On your initial assessment, he is amnestic to the events surrounding his injury, oriented to person, place and time, and is complaining that “the back of my head hurts”. The rest of his exam is unremarkable.
Yes
Yes
No
1. Epidural Hematoma
1. Epidural Hematoma
2. Subdural Hematoma
3. Subarachnoid Hemorrhage
4. Shear injury
5. No acute injury
Have another CT scan in 6 hours
Have another CT scan in 6 hours
Be discharged to home with his mother
Be admitted to the Trauma Service for at least 24 hours
Spend the night in the Emergency Department
Yes
Yes
No
A. When he says he feels fine
A. When he says he feels fine
B. When his mother thinks he is well enough to play
C. After further evaluation demonstrates that he is no longer suffering from post concussive symptoms.
75 year old woman, tripped over dog, striking head on floor. She sustained a brief + loss of consciousness, prior to waking up with her daughter at her side.
75 year old woman, tripped over dog, striking head on floor. She sustained a brief + loss of consciousness, prior to waking up with her daughter at her side.
Daughter transports her to local Emergency Department.
Daughter transports her to local Emergency Department.
She is awake and alert, and complains of “the worst headache of my life”
She is evaluated by the ED staff, who call you once they see her head CT
A. Epidural Hematoma
A. Epidural Hematoma
B. Subdural Hemorrhage
C. Subarachnoid Hemorrhage
D. SAH & EDH
E. SDH & EDH
F. No acute injury
Cervical spine fractures
Cervical spine fractures
Parietal skull fractures
C. “the worst headache of my life”
D. Venous bleeding
A. Require surgical evacuation
A. Require surgical evacuation
B. Produce “the worse headache of my life”
C. Produce significant “mass effect”
D. A & C
E. All of the above
F. None of the above
Get her a diet and a blanket
Get her a diet and a blanket
Consult PT and OT
Prevent hypoxia and hypovolemia
Contact case management and arrange for transfer to skilled nursing facility
Yes
Yes
No
22 year old man s/p single vehicle MVC vs. tree. EMS finds him unresponsive (GCS 3). He is intubated without drugs, IV access is initiated and he is transported to the ED for evaluation.
22 year old man s/p single vehicle MVC vs. tree. EMS finds him unresponsive (GCS 3). He is intubated without drugs, IV access is initiated and he is transported to the ED for evaluation.
Trauma evaluation notes a right forearm deformity, and scattered abrasions.
Prior to admission to the Trauma Service, he is taken through the CT scanner:
Epidural Hematoma
Epidural Hematoma
Subdural Hematoma
Subarachnoid Hemorrhage
Shear injury
5.No acute injury
Pressure ulcers, contractures
Pressure ulcers, contractures
Family arguments, disagreements
Hypoxia, hypovolemia
Pain, discomfort
He has an ICP monitor placed, with ICP’s ranging 8-10.
He has an ICP monitor placed, with ICP’s ranging 8-10.
He remains hemodynamically stable, and is cleared to have his forearm repaired by the Orthopaedic service.
On Hospital Day #4, he is trached and PEG’d, and weaned from the ventilator by hospital day #5.
His ICP monitor is discontinued.
He may never wake up
He may never wake up
The longer he remains comatose, the less likely it is for him to wake up
If he wakes up, he will likely emerge through several phases of the RLA scoring system.
It will take up to a year to determine his long term, “new normal”, baseline.
