Page 1 of 1: Head Trauma case

Kai1111 · Credits: 2036 My Scrapbook

Found this dilemma on a question bank...

20M trauma thrown from a bicycle with closed head injury. Hemodynamically stable.
Do a focused neuro exam.
-Pt had C-spine, no airway protection, Rt face lac.
-GCS 8(1E,2V,5M-able to localize pain on sternal rub)
-CN exam normal (pupils, cornea, state calorics but not done, gag)
-? decreased reflexes, normal tone, -ve Babinski, normal rectal tone
-no hemotympanum
-Thats all you could do - pt did not respond!

Any other thoughts.....the task is to just 'do a neuro exam,' but it seems like a lot of time was left over....is something missing? At first I thought, with a GCS of 8, if he's being transported, then he should be intubated....but that isn't the task..just do a neuro exam.

I think that maybe his GCS of 8, may actually be 6 as the sternal rub localizing may have been decorticate posturing?

Should a blood sugar be checked? O2 sat?
Would have checked withdrawal to pain on all 4 extremities....assume he probably did.

Just for interest sake, would you intubate this guy before transport with a GSC of 8 and a good gag reflex?
He'd at least get an NG tube and of course, lines, o2 etc.

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