The symptoms, signs and emergency management of major injuries
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
The Advanced Trauma Life Support course has established the value of a standardized approach to trauma assessment and management, especially for the lone practitioner faced with one or more patients who have sustained severe injuries. Airway obstruction in an unconscious patient can usually be relieved by lifting the jaw forwards, but it may require the insertion of a finger into the mouth to extract debris. Mouth-to-mouth resuscitation should be started immediately if the patient remains cyanosed or apnoeic after the airway has been cleared. An unconscious or immobile patient can rapidly become hypothermic, which exacerbates coagulopathy and acidosis. All patients who are unconscious or suspected of having multiple or serious injuries should be admitted directly to the resuscitation area of the accident and emergency department. Monitoring of the Glasgow Coma Scale score must be carried out at frequent intervals in comatose patients with a score of 8 or less.
Central nervous system lesions
E Glucksman in MCQs in Neurology and Neurosurgery for Medical Students, 2022
Central pontine myelinolysis is a fatal complication that is due to rapid correction of hyponatraemia. An acute onset of paralysis, dysarthria, dysphagia, diplopia and eventual loss of consciousness may occur following correction. Clinical vasospasm can present with a reduced Glasgow Coma scale score or delayed ischaemic neurological deficit (stroke) and is considered to occur as a result of irritation of the blood vessels by the subarachnoid blood. If the mass enlarges further, it exceeds the critical level and the Intracranial Pressure (ICP) then increases very rapidly as auto-regulation fails. In these patients, mannitol (a diuretic) can be used to reduce the ICP prior to more definitive neurosurgical intervention. If the mass enlarges further, it exceeds the critical level and the ICP then increases very rapidly as auto-regulation fails. In these patients, mannitol (a diuretic) can be used to reduce the ICP prior to more definitive neurosurgical intervention.
Coma and reduced level of consciousness
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
Coma and reduced level of consciousness may result either from global cerebral dysfunction or from pathology affecting the reticular activating system located in the brainstem. Global cerebral dysfunction may be caused by systemic disease or by specific central nervous system disorders. Damage to the reticular activating system may result from pathology directly affecting the brainstem, or from indirect compression of this area due to raised intracranial pressure. In clinical practice, the causes of coma and reduced conscious level are most conveniently classified into systemic and central nervous system categories. Local central nervous system pathology may be further classified into infectious, inflammatory, vascular, neoplastic and miscellaneous categories. Confusion in the elderly may be precipitated by almost any acute illness. Conditions that commonly present with acute confusion in the elderly include urinary retention, constipation and myocardial infarction. Glasgow Coma Scale score, this is a standardised method of measuring a patient's level of consciousness.
Utility of Glasgow Coma Scale-Extended in symptom prediction following mild traumatic brain injury
Published in Brain Injury, 2006
Angela I. Drake, Eric C. McDonald, Nathalie E. Magnus, Nicola Gray, Kim Gottshall
Study objective: To examine the efficacy of the Glasgow Coma Scale-Extended (GCS-E) for the prediction of symptoms commonly associated with mild traumatic brain injury (TBI). Method: Three hundred and sixty-one participants with a mild TBI were evaluated using the GCS-E and the Standardized Assessment of Concussion. A sub-group of 185 participants took part in a more extensive evaluation, which also included measures of depression and vestibular symptoms. All participants had a Glasgow Coma Scale score of 15, but experienced varying lengths of post-traumatic amnesia (PTA) as measured by the GCS-E. Results: Use of the GCS-E for assessment of PTA duration revealed that longer lengths of amnesia following mild TBI were associated with greater incidence of dizziness, depression and cognitive impairments during the first weeks after injury. Conclusion: Results suggest that the GCS-E is a useful tool for the prediction of symptoms associated with mild TBI.
Comfort Measures for Severe Diffuse Axonal Injury: A Patient's Last Wish
Published in AJOB Neuroscience, 2016
A physically active 60-year-old male suffered severe diffuse axonal injury due to a motor vehicle accident. His initial Glasgow Coma Scale score was 3. His magnetic resonance imaging (MRI) showed midbrain, corpus callosum, and pontine involvement with intracerebral hemorrhage and bilateral subdural hygromas. He scored 3 on the extended Glasgow Outcome Scale (GOSE) (lower severe disability) and 18 on the disability rating scale. His 14-day mortality risk was estimated to be 83.6% and risk of unfavorable outcome at 6 months 96.0%. Although he did not have a progressive illness or disease, based on the incurability of his condition, his very low level of functioning, and his previously stated wishes not to prolong his life should it be at the point where it now was, a bioethics committee meeting was held. He was then discharged on home hospice and expired peacefully within 24 hours of arriving home.
Preliminary Validation of a New Measure of Negative Response Bias: The Temporal Memory Sequence Test
Published in Applied Neuropsychology: Adult, 2015
Omer Hegedish, Naama Kivilis, Dan Hoofien
The Temporal Memory Sequence Test (TMST) is a new measure of negative response bias (NRB) that was developed to enrich the forced-choice paradigm. The TMST does not resemble the common structure of forced-choice tests and is presented as a temporal recall memory test. The validation sample consisted of 81 participants: 21 healthy control participants, 20 coached simulators, and 40 patients with acquired brain injury (ABI). The TMST had high reliability and significantly high positive correlations with the Test of Memory Malingering and Word Memory Test effort scales. Moreover, the TMST effort scales exhibited high negative correlations with the Glasgow Coma Scale, thus validating the previously reported association between probable malingering and mild traumatic brain injury. A suggested cutoff score yielded acceptable classification rates in the ABI group as well as in the simulator and control groups. The TMST appears to be a promising measure of NRB detection, with respectable rates of reliability and construct and criterion validity.
Related Knowledge Centers
- Trauma Severity Indices
- Neurology
- Level of Consciousness
- Head Injury
- First Aid
- Emergency Medical Services
- Physician