IMAGE: Raccoon eyes and CSF leak from nose, indicative of anterior basilar skull fracture.
IMAGE: Table 10-2: Glasgow Coma Scale (on page 154).NOTE: See also Appendix F: Trauma Scoring in the Prehospital Care Setting.In TBI patient, a Glasgow Coma Scale score of 8 or less is considered evidence of a severe brain injury. GCS score that is determined in field serves as baseline for patient; be sure to record it. Record score for each part of GCS, not just total score. Perform a finger-stick glucose on all patients with altered mental status.
Head Trauma - 2
Glasgow Coma Scale
Suspect severe brain injury
*Decorticate posturing to pain
**Decerebrate posturing to pain
Head Trauma - 3
Level Of Consciousness
• Glasgow Coma Scale
• Any trauma to the scalp, skull, or brain
• Head trauma includes an alteration in
consciousness no matter how brief
• It include fractures to
the cranium and the
face, can be associated
with brain injury.
• It is divided into:
– Open skull fracture:
cranium is fractures and
scalp is lacerated.
– Closed skull fracture:
scalp is lacerated but
cranium is intact.
– Basal skull fracture
GCS = 9-13
Clinical presentation varies widely
10% of patients
Specialized Subset = “Talk and Die Syndrome”
Initially, talkative and without significant signs of external injury
Within 48 hours of injury, rapidly deteriorate
Epidural Hematoma is cause in 78-80% of cases
Patients with “talk and die syndrome” who present with a GCS > 9
but who deteriorate have been shown to have a worse outcome than
patients who present with severe TBI at outset
– ? Delayed Diagnosis
Ghana Emergency Medicine
Ghana Emergency Medicine Collaborative
Advanced Emergency Trauma Course
Advanced Emergency Trauma