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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Discuss the goals of cerebral resuscitation.

  • Interpret parameters beneficial in assessing the severity of the brain injury.

  • Describe the impact of prior antithrombotic therapy on traumatic brain injury and devise an appropriate treatment plan for patients with traumatic brain injury while on antithrombotic therapy.

  • Discuss the therapeutic management of traumatic brain injury and increased intracranial pressure associated with acute brain injury.

  • Recommend appropriate therapy to prevent medical complications after brain injury.

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PATIENT PRESENTATION

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Chief Complaint

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Not available—the patient was brought to the ED by EMS as a trauma code.

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HPI

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Oliver Johnson is a 55-year-old man who was brought to the ED after suffering a ski accident while on vacation with his wife. His wife reports that he was unarousable at the scene of the accident.

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PMH (As Per Patient’s Wife)

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  • Dyslipidemia

  • NSTEMI (1 year ago)

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FH

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Unknown

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SH

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Unknown

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ROS

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Unobtainable

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Meds

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  • Aspirin 325 mg PO daily

  • Clopidogrel 75 mg PO daily

  • Simvastatin 40 mg PO daily

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All

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NKDA

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Physical Examination

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Gen
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WDWN man who does not speak, open his eyes, or move on verbal stimuli. On painful stimuli, he does not speak or open his eyes but does exhibit flexor posturing.

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VS
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BP 87/60 mm Hg, P 126 bpm, RR 30, T 38.3°C; Wt 85 kg, Ht 6′0″

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Skin
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Multiple bruises on the face and extremities bilaterally

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HEENT
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The patient has multiple soft tissue injuries to the face. The left pupil is 5 mm and nonreactive to direct light, and the right pupil is 2 mm and slowly reactive to light. EOMs are not reactive and not moving. External inspection of ears and nose reveals no acute abnormalities. There is some dried blood in the mouth. The head has a large open scalp laceration on the forehead with surrounding ecchymoses. Neck is in a cervical collar; therefore, movement was not attempted. There are no gross masses in the neck.

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Lungs
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Rhonchi and crackles present bilaterally with thick secretions

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Heart
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Sinus tachycardia with S1 and S2 present

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Abd
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Soft with no masses or tenderness but decreased bowel sounds. There is no gross hepatosplenomegaly.

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Ext
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No nontraumatic edema is noted

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Neuro
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