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Traumatic Brain Injury Part III
Part 3: Assessment and Management of Severe TBI
Summary
The Glasgow Coma Scale (GCS), a clinical scoring system designed to assess coma, impaired consciousness, and motor responses, is one of the most commonly used to communicate severity of injury (it should be scored after basic resuscitation). Patients with GCS scores of 3 to 8 are classified as severe TBI, those with scores of 9 to 12 are classified as moderate TBI, and those with scores of 13 to 15 are classified as mild TBI. Patients with severe TBI require intensive care admission either to a surgical-trauma ICU or a neuro-ICU depending on associated injuries and/or local hospital organisation and resources. Patients with moderate injury may also require close monitoring and an ICU setting for a decline in neurological status and/or airway compromise and/or to monitor ICP if there is a risk of evolution of a mass lesion.
General Information
Enrolled trainees 1894
Open 03.05.2019
Available for ESICM members
Student effort 3
Last Updated August 8, 2022
Intended Learning Outcomes
At the end of the Unit the student should able to:
- Identify the most important aspect in the assessment of severe patients with TBI
- Explain the role of ICP monitoring in patients with TBI
- Describe further monitoring techniques for TBI patients
- Describe therapeutic interventions in TBI patients and list the criteria for specific interventions such as surgery
- Discuss basic and second line interventions in brain oedema in patients with TBI
- Describe the diagnosis and management of intracranial infections in patients with TBI
- Describe the diagnosis and management of seizures in patients with TBI
Relevant competencies in CoBaTrICE
- 2.2 Undertakes timely and appropriate investigations
- 2.8 Liaises with radiologists to organise and interpret clinical imaging
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.6 Recognises and manages the patient with neurological impairment
- 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
- 6.3 Manages the care of the patient following craniotomy under supervision
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