Case Study: Severe Head injury with avulsed pinna Right; epidural hematoma right occipital area Assessment

Level of consciousness through the Glasgow Coma Scale Rationale

Its the earliest and most sensitive indicator that something is changing. A score of 13-15 indicates mild injury, a score of 9-12 indicates moderate injury, and a score of 8 or less indicates severe injury. A. Arousal/ wakefulness: patient can open Most fundamental part of the LOC which is his eyes spontaneously to voice or pain controlled by the brain stem; if patient opens his eyes, thus wakefulness center in the brain is still functioning or intact A. a. b. c. d. Awareness Orientation Memory Calculation Fund of knowledge A higher function controlled by the reticular activating system in the brain stem; the ability to interact with and interpret the environment.

Checking the motor response

A. A. Following commands Localizing Highest level of motor response Normal response in response to stimuli; determined by purposeful movement Third highest level of motor response; patient pulls away after continuous infliction of pain Abnormal motor response that may indicate trouble. -Scored using fraction Indicator of motor weakness

A.

Withdrawing

A. a. b.

Posturing Flexion(decorticate) Extension (decerebrate)

Muscle strength a. Drift b. coordination Monitoring vital signs A. BP: Watch out for a BP with a rising systolic pressure and an unchanged diastolic pressure, resulting in a widening pulse pressure. B. RR: Watch out for Bradycardia with rate between 40- 50 and abnormal respiration. C. Temperature

*known as the Cushings triad, are late signs of increased ICP and indicate that the brain is about to herniated. Fever increases the brains oxygen demand 6% 10% for every degree above normal.

Other Assessments: Assess for change in pupil size and reactivity to light

Normal: 2.5 5 mm Anisocoria/ Assymetrical response, sluggish reponse to light may indicate 3rd cranial nerve compression Pinpoint pupil: Pontine Hemorrhage Bilateral dilated unreactive pupil: may indicate severe midbrain injury

Assess for,impairment of consciousness, May indicate increasing intracranial pressure Headache, Vomit ing ,Convulsions, Papilloedema, Bradycardia, Hypertension, Changes in respiration, B/l Babinskis sign Assess reflexes and cranial nerves Cranial nerve # 3- Dilated non reacting pupil, ptosis,diplopia, divergent paralytic squint Cranial nerve # 7 -Facial palsy Cranial Nerve # 4- Diplopia on downward gaze(SOParalysis) Cranial Nerve # 6- Diplopia on looking outwards toparalysed side(LR Paralysis) Cranial nerve # 8 -Loss of hearing, vertigo, nystagmus Cranial nerve # 1-Anosmia Cranial nerve #2- Blurring of vision, field defects