Case Explanation: Explanation of Answers
•1. Correct answer is 8T (E2, V1, M5). GCS is scored by eye opening (1=no eye opening, 2=opening to pain, 3=opening to voice, 4=open spontaneously), verbal score (5=oriented, 4=confused, 3=saying words, 2=moaning, 1=non verbal, t=intubated), motor score (6=following commands, 5=localizing, 4=withdrawing, 3=flexor posturing, 2=extensor posturing, 1=no movement)
•2. The correct answer is mannitol. The TBI guidelines in 2016 give a Level 1 recommendation against steroids for severe TBI. Hyperventilation can be used in an acute setting for increased ICP, but longterm hyperventilation is not recommended in the TBI guidelines (Level IIB). Early (within 48 hours) prophylactic hypothermia is not recommended (Level IIB).
•The correct answer is Heparin SQ BID. Heparin gtt and BID lovenox would result in increased risk of intracranial hemorrhage. The IVC filter is not recommended for DVT prophylaxis. It may be used in the setting to prevent PE in the setting of DVT and severe contraindications for anticoagulation.
•Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet, 1974.
•Carney et al. Guidelines for the management of severe traumatic brain injury, 4th edition. Neurosurgery, 2016.
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