big classification head injury

Grade 1:   __ Transient Confusion  Traumatic Brain Injury (TBI) can be defined as damage to brian tissue caused by an external mechanical force as evidenced by 1. It consists of a 1-5 rating of three areas: best occular response, speech, and movement/response to pain resulting in a best possible score of 15. 1. If none of Criteria A or B apply, classify as Symptomatic (Possible) TBI if one or more of the following symptoms are present:                                     Says incomprehensible sounds = 2; No response = 1. Head injury symptoms may occur immediately following trauma or develop slowly over time.   A TBI resulting from something passing through the skull into brain, such as a bullet or fragments from an explosion, is called a penetrating or open head injury.   1. Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition, and the AANS and CNS leadership for their endorsement, which appears on the title page. 5. − Emotions out of proportion to circumstances (distraught, crying for no apparent reason) The Traumatic Coma Data Bank: design, methods, and baseline characteristics. Post-traumatic anterograde amnesia of momentary to less than 24 hours 2. Focal neurologic deficits, which may or may not be transient.   Traumatic brain injury (TBI), also known as acquired brain injury, head injury, or brain injury, causes substantial disability and mortality. Any loss of memory for events immediately before or after the injury; 1991;75. 5 - 60 minutes...........Mild Glasgow Coma Scale:   13-15 mild; 8-12 moderate; < 7 = severe head trauma, (poor prognosis) (Teasdale & Jennett, 1974).                    __ No Loss of Consciousness In 2001 Cantu's system was updated and included additional symptoms: 1 − Persistent low grade headache "complicated mild" or "moderate" when the GCS exceeds 12 but accompanied by intracranial lesion on neuroimaging (skull fractures do not necessarily meet this criterion) - Williams, Levin, & Eisenberg, 1990 The face and jaw are located in the front of the head, and brain injury may also be associated with injuries to these structures. The Glasgow Coma scale is frequently employed at time of injury by Emergency Medical Technicians and during acute admission for brain injury. Defense and Veterans Brain Injury Center Working Group on the Acute Management of Mild Traumatic Brain Injury in Military Operational Settings. "complicated mild" or "moderate" when the GCS exceeds 12 but accompanied by intracranial lesion on neuroimaging (skull fractures do not necessarily meet this criterion) - Williams, Levin, & Eisenberg, 1990. Cofield Classification of Rotator Cuff Tears (Cofield 1982) Cofield, Surg Gynec Obstet, 154(5): 667-672, 1982. Forces causing brain injury include the head being struck by an object, the head striking an object, the brain undergoing an acceleration/ deceleration movement without direct external trauma to the head, a foreign body penetrating the brain, forces generated from events such as a blast or explosion, or other force yet to be defined. A skull fracture occurs when the bone of the skull cracks or breaks. Lt Col Reynolds __ one or more neurological symptoms Foulkes MA, Eisenberg HM, Jane JA, et al. Intracranial lesion. anxiety, "complicated mild" or "moderate" when the GCS exceeds 12 but accompanied by intracranial lesion on neuroimaging (skull fractures do not necessarily meet this criterion) - Williams, Levin, & Eisenberg, 1990 Loss of consciousness of 30 minutes or more 1991;75. 1 - 4 weeks..............Very severe Four Score Grade 2:   Loss of Consciousness < 5 Minutes OR Post Traumatic Amnesia of 30 Minutes to 24 Hours J Neurosurg. The Department of Defense and the Department of Veterans Affairs (May 2007), by consensus, have defined traumatic brain injury (TBI) as any traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event: Grade 2:   Loss of Consciousness < 5 Minutes OR Post Traumatic Amnesia of 30 Minutes to 24 Hours GCS score of 9-12 or higher Funding Source . Innsbruck Coma Scale Glasgow Coma Scale:   13-15 mild; 8-12 moderate; < 7 = severe head trauma, (poor prognosis) (Teasdale & Jennett, 1974). Cantu Concussion Severity Grades  (1991) 3. Head bleeds can cause permanent brain damage or even death. Journal of Neurotrauma. __ one or more neurological symptoms, Type III: Lt Col Reynolds injury, head trauma, peripheral neural injuries, and related neural injuries such as stroke. A TBI that results from either an object hitting the head or from the head hitting something forcefully, such as the dashboard of a car, is referred to as a nonpenetrating or closed head injury. PTA Duration............Severity of Injury Foulkes MA, Eisenberg HM, Jane JA, et al. Reference:  James F. Malec, Allen W. Brown, Cynthia L. Leibson, Julie Testa Flaada, Jayawant N. Mandrekar, Nancy N. Diehl, Patricia K. Perkins. This tends to be less severe than spinal damage or head injuries, but can still cause significant problems. Open Versus Closed TBI. Edinbugh-2 Coma Scale. __ one or more neurological symptoms Journal of Neurotrauma. − Any period of loss of consciousness (paralytic coma, unresponsiveness to arousal.   Any loss of memory for events immediately before or after the accident A TBI resulting from something passing through the skull into brain, such as a bullet or fragments from an explosion, is called a penetrating or open head injury. Grade 3: Loss of Consciousness > 1 minute, Post-traumatic amnesia > 24hrs, or signs and symptoms < 1 week. Grade 2: Loss of Consciousness < 1 minute or post-traumatic amnesia 30 min.- 24 hrs − Delayed verbal and motor responses (slow to answer questions or follow instructions) Dec. 2006 National Institute of Health (NIH) sponsored Traumatic Coma Data Bank (TCDB). Depressed, basilar or linear skull fracture (dura intact) Depressed, basilar or linear skull fracture (dura intact)                               Flexor (decorticate) posturing to pain = 3; Extensor (decerebrate) posturing to pain = 2; No response = 1 GCS score of 9-12 or higher Head/Face Injury Further Detail Dec 02: "Any injury of this nature is complex and timescales are uncertain but it's safe to say that Raul's most immediate needs are simple: space, rest and peace." Cantu, 1991     Cantu's system is often used in reasearch involving sports concussion Penetrating injury can be caused by high-velocity projectiles or objects of lower velocity such as knives, or bone fragments from a skull fracture that are driven into the brain. Glasgow Coma Scale (GCS) score greater than 12 Severity of Injury Based on Post-Traumatic Amnesia (PTA) Duration (Bigler, as cited in Lezak, 1995). Any period of loss of or a decreased level of consciousness; Open Head Injury. 4. 2. "Very Severe" GCS = 3-5 "Severe" GCS = 6–8 (Zhang, Jiang, Zhong, Yu, & Zhu (2001, Chinese J. of Traumatology). What Is Traumatic Brain Injury? − Intolerance of bright lights or difficulty focusing vision Traumatic Brain Injury Definition Ruff Concussion Grades: Length of hospital stay less than 48 hours 2. Neurological deficits (e.g., weakness, balance disturbance, praxis, paresis/plegia, change in vision, other sensory alterations, aphasia.)                                     Says incomprehensible sounds = 2; No response = 1 Severity of Injury Based on Post-Traumatic Amnesia (PTA) Duration (Bigler, as cited in Lezak, 1995).   3. Probably the most well known car accident injury is whiplash. One or more of the following present: • Intracerebral hematoma, •Subdural hematoma, Epidural hematoma, Cerebral contusion, Hemorrhagic contusion, Penetrating TBI (dura penetrated), Subarachnoid haemorrhage, Brain Stem Injury − Sleep disturbance Ruff Concussion Grades: Mayo Head Injury Classification System (2007) Maj Hemstad Motor response  Follows commands = 6; Makes localizing movements to pain = 5; Makes withdrawal movements to pain = 4; If a person meets these criteria, they should be diagnosed as having sustained a TBI. The following criteria define moderate traumatic brain injury (TBI): Patients diagnosed with blunt cerebrovascular injury should receive antithrombotic therapy (aspirin or heparin) to decrease the risk of stroke and stroke-related mortality 5. If none of Criteria A apply, classify as Mild (Probable) TBI if one or more of the following criteria apply: − Easy fatigability Results: A total of 1,232 patients had an abnormal head CT finding. Intracranial lesion. 5. Death due to this TBI post-traumatic amnesia lasting more than 12 hours subsequent to the closed head injury, and J Neurosurg. The injury may be only a minor bump on the skull or a serious brain injury. The above criteria define the historical event of a TBI.   It consists of a 1-5 rating of three areas: best occular response, speech, and movement/response to pain resulting in a best possible score of 15. (e.g., confusion, disorientation, slowed thinking);   If none of Criteria A apply, classify as Mild (Probable) TBI if one or more of the following criteria apply: Eye opening    Spontaneous = 4 ; To speech = 3; To painful stimulation = 2; No response = 1, Motor response  Follows commands = 6; Makes localizing movements to pain = 5; Makes withdrawal movements to pain = 4; TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age. 1 - 24 hours.............Moderate Operative intracranial lesion Verbal response  Oriented to person, place, and date = 5; Converses but is disoriented = 4; Says inappropriate words = 3 Type II: Four Score National Institute of Health (NIH) sponsored Traumatic Coma Data Bank (TCDB). 1 - 7 days...............Severe __ definite LOC with time unknown or < 5 minutes Post-traumatic anterograde amnesia of momentary to less than 24 hours 1. The Traumatic Coma Data Bank: design, methods, and baseline characteristics. − Intolerance of loud noises, sometimes ringing in the ears Definition of Severe Traumatic Brain (TBI) involves a GCS score below 9 within 48 hours of the injury.   1. We then developed brain injury guidelines (BIG) based on the individual patient's need for observation or hospitalization, RHCT, or neurosurgical consultation. 2. The leading causes of TBI that resulted in emergency department visits were falls, being struck by an object and motor vehicle crashes. This may be caused by accidents, falls, hits, weapons, and other causes. 5.     When it affects the brain, they’re called a traumatic brain injury, or TBI. Other classification using GCS Journal of Neurotrauma. Any alteration in mental state at the time of the injury new onset of seizures or marked worsening of pre-existing seizure disorder that occurs within the first six months. Any alteration in mental state at the time of the accident Defense and Veterans Brain Injury Center Working Group on the Acute Management of Mild Traumatic Brain Injury in Military Operational Settings. The current version of the Diagnosotic and Statistical Manual - IV has a limited classification system with respect to concussion, including Post-Concussional Disorder in a section of diagnoses requiring further study. This system was used by our own Dr. Phalin in his doctoral study of different models for detecting recovery in sports concussions. In addition, traumatic brain injury can result from bullet wounds or other injuries that penetrate the skull and brain.Doctors classify traumatic brain injury a… __ one or more neurological symptoms Psychological and Neuropsychological Assessment. Operative intracranial lesion A head injury is any trauma to the scalp, skull, or brain. Less severely impacted TBI's would be classified as Cognitive Disorder. Loss of consciousness due to brian trauma, 2. post-traumatic amnesia (PTA), 3. skull fracture, or 5. objective neurological findings attributed to TBI on physical examination or mental status examination (1999 - Traumatic Brain Injury Model Systems National Data Center) 4. Additional Resources: Most classifications of traumatic brain injury include considerations of alteration or loss of consciousness, coma level and duration, amnesia, complications such as fracture or intracranial findings. Any loss of memory for events immediately before or after the accident __ altered mental state or transient loss of consciousness (LOC) CDC defines a traumatic brain injury (TBI) as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Verbal response  Oriented to person, place, and date = 5; Converses but is disoriented = 4; Says inappropriate words = 3

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