EM Cases · Traumatic brain injury
Severe TBI with herniation signs — resus station
ACEM OSCE on preventing secondary brain injury, intubation threshold, osmotherapy and neurosurgical escalation.
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Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
GCS 7 after fall; unilateral fixed pupil develops during resus.
Stem
All persons, presentations and observations in this station are fictional and invented for teaching assessment; they do not describe a real person.
References5ShowHide
- [1]Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (CRASH trial). Lancet, 2004.PMID 15474134
- [2]Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury (DECRA). New England Journal of Medicine, 2011.PMID 21434843
- [3]Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension (RESCUEicp). New England Journal of Medicine, 2016.PMID 27602507
- [4]Tatro HA, McMillen JC, Hamilton LA, et al. 23.4% Sodium Chloride Versus Mannitol for the Reduction of Intracranial Pressure in Patients With Traumatic Brain Injury: A Single-Center Retrospective Cohort Study. Ann Pharmacother, 2021.PMID 33345546
- [5]Chesnut RM, Marshall SB, Piek J, et al. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien), 1993.PMID 8310858