Traumatic brain injury is damage to the brain from a blow, jolt or penetrating injury to the head, ranging from mild concussion to severe injury with coma. Treatment focuses on preventing secondary injury from low oxygen, low blood pressure and rising pressure in the skull.
Key symptoms
- Headache, confusion or memory loss about the event
- Loss of consciousness
- Vomiting or seizure
- Dizziness, blurry vision or slurred speech
What you find on exam
- Primary survey with cervical spine protection
- Glasgow Coma Scale and pupil checks, repeated over time
- Scalp wounds, skull fracture signs and bruising behind the ears or around the eyes
- Focal weakness and signs of herniation
Tests
- Non-contrast CT head based on clinical decision rules
- CT of the cervical spine if indicated
- Glucose, coagulation tests, blood count and alcohol level
Treatment basics
- Keep oxygen saturation above 94 percent and avoid low blood pressure
- Elevate the head of the bed to 30 degrees
- Hypertonic saline or mannitol for signs of raised pressure
- Reverse anticoagulation and get an urgent neurosurgery consult for bleeding
- Mild injury: observation, return precautions and gradual return to activity
Red flags
- Falling Glasgow Coma Scale score or unequal pupils
- Repeated vomiting or a seizure
- High blood pressure with slow heart rate and irregular breathing
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.