Traumatic brain injury physical examination: Difference between revisions
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{{CMG}} {{JE}} | {{CMG}} {{JE}} | ||
==Overview== | ==Overview== | ||
Physical examination is the most important, first most, inexpensive, and quick component of the assessment of a patient with acute traumatic brain injury. This includes vital signs, general examination | Physical examination is the most important, first most, inexpensive, and quick component of the assessment of a patient with acute traumatic brain injury. This includes vital signs, general examination with trauma survey of the whole body and most importantly neurologic examination. The neurologic exam of a traumatic brain injury patient includes the following key components. | ||
*Level of [[Consciousness|consciousness]], | *Level of [[Consciousness|consciousness]], | ||
*[[Glasgow Coma Scale|GCS]] | *[[Glasgow Coma Scale|Glasgow Coma Scale (GCS)]] | ||
*[[Frontal lobe|Higher]] function | *[[Frontal lobe|Higher]] function | ||
*[[Cranial nerve examination]] | *[[Cranial nerve examination]] | ||
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==Physical Exams== | ==Physical Exams== | ||
Measuring vital signs is the first | Measuring vital signs is the first thing to do. A wide pulse pressure in the setting of a new onset bradycardia and bradypnea could mean elevated intracranial pressure. [[Cushing's triad|Cushing's]] reflex is a physiological response to an acute increase in intracranial pressure, leading to a triad of widened pulse pressure, bradycardia and irregular respirations. | ||
General examination with trauma survey includes assessment of injuries else where, including contusions, fractures, dislocations, and/or soft tissue injuries. | |||
Neurologic examination is obviously the most important part of physical examination. Level of consciousness, as assessed by [[Glasgow coma scale|GCS]] is considered to be the best predictor of the prognosis in the acute traumatic brain injury. The components of [[Glasgow coma scale|GCS]] include assessment of best verbal, eye and motor response, followed by scoring. The minimum score is 3 and the maximum score is 15. | |||
Common physical examination findings of traumatic brain injury include<ref name="pmid29083790">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=29083790 | doi= | pmc= | url= }} </ref> | Common physical examination findings of traumatic brain injury include<ref name="pmid29083790">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=29083790 | doi= | pmc= | url= }} </ref> | ||
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**[[Mental status examination|Mental status]] | **[[Mental status examination|Mental status]] | ||
**[[Mood]] or [[behavior]] changes | **[[Mood]] or [[behavior]] changes | ||
==References== | ==References== | ||
Revision as of 17:54, 25 August 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Joanna Ekabua, M.D. [2]
Overview
Physical examination is the most important, first most, inexpensive, and quick component of the assessment of a patient with acute traumatic brain injury. This includes vital signs, general examination with trauma survey of the whole body and most importantly neurologic examination. The neurologic exam of a traumatic brain injury patient includes the following key components.
- Level of consciousness,
- Glasgow Coma Scale (GCS)
- Higher function
- Cranial nerve examination
- Motor examination
- Sensory examination
- Examination of cerebellar function and gait
Physical Exams
Measuring vital signs is the first thing to do. A wide pulse pressure in the setting of a new onset bradycardia and bradypnea could mean elevated intracranial pressure. Cushing's reflex is a physiological response to an acute increase in intracranial pressure, leading to a triad of widened pulse pressure, bradycardia and irregular respirations.
General examination with trauma survey includes assessment of injuries else where, including contusions, fractures, dislocations, and/or soft tissue injuries.
Neurologic examination is obviously the most important part of physical examination. Level of consciousness, as assessed by GCS is considered to be the best predictor of the prognosis in the acute traumatic brain injury. The components of GCS include assessment of best verbal, eye and motor response, followed by scoring. The minimum score is 3 and the maximum score is 15.
Common physical examination findings of traumatic brain injury include[1]
- Signs of physical trauma to the skull.
- Neurologic deficit
- Motor and sensory skills
- Hearing and speech
- Coordination and balance
- Mental status
- Mood or behavior changes