Symptoms Of Mtbi Generally Fall Into The Following Four Categories
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A combination of risk factors that may indicate need for neuroimaging include:
-age < 2 yo -recurrent vomiting -loss of consciousness -severe mechanism of injury -severe or worsening headache -amnesia -non-frontal scalp hematoma -GCS < 15 -clinical suspicion for skull fracture
Examples of validated scales for mTBI include, but are not limited to:
-post-concussion symptom scale -health and behavior inventory -post-concussion symptom inventory -acute concussion evaluation
Factors associated with poor prognosis:
-older age or hispanic ethnicity -lower socio-economic status -history of intracranial injury -premorbid histories of mTBI or increased pre-injury symptoms -neurological or psychiatric disorder -learning difficulties or lower cognitive ability -family and social stressors
Warning signs of serious brain injury:
-a headache that gets worse and does not go away -significant nausea or repeated vomiting -increased confusion, restlessness, or agitation -slurred speech, drowsiness, or inability to wake up -weakness, numbness, or decreased coordination -loss of consciousness, convulsions, or seizures
In its pediatric mTBI guideline, CDC defined mTBI to be inclusive of pediatric patients:
Wtih GCS scores of 13 - 15, with or without the complication of intracranial injury on neuroimaging.
Pediatric brain is more susceptible to mTBI due to:
-developing brain (not myelinated) -developing body (less stable muscles and bones) -developing curiosity
symptoms of mTBI generally fall into the following 4 categories:
somatic, cognitive, affective, sleep
Which indications should prompt admission to a hospital for a patient with mTBI?
-any signs of intracranial injury -deteriorating neuro/cognitive symptom eval
What happens when an athlete's symptoms return after they've initiated a step-wise return to:
Athlete should drop back to the previous level at which they were asymptomatic and try to move forward only after a 24 hour period of rest has passed and they are again asymptomatic.
When discharging a patient with mTBI, you should counsel patients and their parents to:
follow 1-2 days of rest, gradually begin return to non-sports activity as long as symptoms do not worsen.
A 6 yo boy diagnosed with mTBI complains of continuing headaches one week after the injury but no other symptoms. What do you recommend?
OTC analgesics
When do you see symptoms of subdural hematoma?
30 - 40 minutes after the injury
What are the symptoms do you see in athletes and refer them 4-6 weeks post injury?
painful headache chronic headache dizziness lack of sleep cognitive impairment
what is chronic traumatic encephalopathy?
-neurodegenerative disease due to repetitive head impact and subconcussive head impacts
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