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LEARNING OBJECTIVES

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

  • 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.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH (As Per Patient’s Wife)

  • Dyslipidemia

  • NSTEMI (1 year ago)

FH

Unknown

SH

Unknown

ROS

Unobtainable

Meds

  • Aspirin 325 mg PO daily

  • Clopidogrel 75 mg PO daily

  • Simvastatin 40 mg PO daily

All

NKDA

Physical Examination

Gen

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.

VS

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

Skin

Multiple bruises on the face and extremities bilaterally

HEENT

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.

Lungs

Rhonchi and crackles present bilaterally with thick secretions

Heart

Sinus tachycardia with S1 and S2 present

Abd

Soft with no masses or tenderness but decreased bowel sounds. There ...

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