Question 1

A patient is in the emergency department after sustaining a blow to the head in a motor vehicle accident. The patient's Glasgow Coma score (GCS) is 14 and the patient is drowsy. The patient has a small amount of blood in one external auditory canal. Which is a priority in diagnosing the extent of injury in this patient?

A) Close monitoring of pulse, respiration, and oxygenation
B) Continued assessment of neurological status
C) Magnetic resonance imaging of the head
D) Non-enhanced computed tomography of the head

D

Accepted Answer

A non-enhanced computed tomography (CT) of the head is the priority for diagnosing potential intracranial injuries, especially given the presence of blood in the external auditory canal, which may indicate a skull fracture or other serious injury.

Question 2

A patient who sustained a head injury has a Glasgow Coma score (GCS) of 14. The patient's spouse reported that the patient lost consciousness for approximately 7 minutes after falling down the stairs. A head computed tomography (CT) scan does not reveal brain lesions. Which treatment is indicated?

A) Admission to the hospital with a neurosurgical evaluation
B) Continued observation in the emergency department until stability is ensured
C) Discharge to home with close observation by the patient's spouse for 24 hours
D) Dismissal to home with a referral for follow-up with a neurologist

A

Accepted Answer

A GCS of 14 indicates a moderate head injury, and the loss of consciousness for 7 minutes indicates a more significant injury. Therefore, admission to the hospital with a neurosurgical evaluation is indicated to monitor the patient's condition and ensure there are no delayed complications. Even though the CT scan shows no evidence of a brain lesion, a repeat scan may be necessary if there is any concern for cerebral or spinal cord injury. Continued observation in the emergency department or discharge to home with close observation is not appropriate, given the patient's initial presentation and history of injury.

Question 3

A patient is brought to the emergency department after being hit in the head with a baseball. The patient is awake and talking but is confused and disoriented and does not obey simple commands. The patient can point to the area of pain and opens eyes only when commanded to do so. Bystanders report a period of unconsciousness lasting almost 5 minutes. Which severity of traumatic brain injury is likely?

A) Normal
B) Mild
C) Moderate
D) Severe

C

Accepted Answer

The patient's symptoms suggest a moderate traumatic brain injury. Although the patient is awake and talking, they are confused and disoriented and do not obey simple commands. Additionally, they experienced a brief period of unconsciousness. These are all signs of a moderate brain injury.

Deck 29: Head Trauma