CS 1. An 85-yr white female with PMH HTN (hypertension), DM, CKD (chronic kidney disease), CHF,
and hypothyroidism is admitted with status post ground level fall (blunt injury). She is brought into the
ED on a non-rebreather via EMS.
Upon initial exam you find that the patient has a small laceration over her right eye, but no obvious signs
of skull fracture or penetrating injuries.
1. Based on this presentation the information presented on the patient and traumatic brain injuries,
what type of mechanism of injury (MOI) does she have?
A. Blunt
B. Penetrating
C. Blast
When you assess the patient, you find that she has a Glasgow Coma Scale (GCS) of 13 (E3, V4, M6) with
no focal neurological deficits. The patient has a 3mm laceration over her right eye.
2. She has a Glasgow Coma Scale (GCS) of 13 (E3, V4, M6) with no focal neurological deficits.
Which classification of brain injury does she have?
A. Mild 13-15
B. Moderate 9-12
C. Severe 3-8
The patient was diagnosed with basilar skull fracture (primary head injury) and is now complaining of a
headache and is impulsive, attempting to get out of bed despite being told multiple times that she needs to
have someone assist her when getting out of bed because of her risk of falling. She is oriented to person
and place, but not to time or situation continuing to ask to get up to let her dog out and complains that it,
“smells like rubbing alcohol in here”. When you ask her to please sit down, she smiles and gets back in
bed.
1. Your patient has a GCS of 13 and unable to stick out her tongue. What is the most likely basilar
skull fracture associated with this deficit?
A. Anterior (70% case, CN I injury, Raccoon eyes & rhinorrhea)
B. Middle (weak vault, CN II injury, Battle signs & otorrhea)
C. Posterior (uncommon, CN IX, X, XI, XII injury, clivus or occipital bone fx)
CS2. Which of the following patients is most likely to survive a penetrating head injury?
A. An 85-yr female was at the park walking her dog and was stabbed several times in
multiple areas of her head. She was found 4-hr later lethargic with unequal
pupils and minimal movement.
B. A 26-yr male suffered a self-inflicted gunshot wound to the face last night and was
found by his family this morning breathing, but not opening his eyes despite
aggressive attempts to awaken him. (less likely to survive)
C. A 42-yr man about 1 hour ago, had a witnessed ground level fall landing on a steel
rake that penetrated the left side of his head. He is awake and following commands.
This study source was downloaded by 100000820020768 from CourseHero.com on 04-04-2023 10:31:22 GMT -05:00
https://www.coursehero.com/file/92229205/TBI-Case-Studydocx/
, CS3. The patient is a 35-yr HF in the Neuro ICU status post motor vehicle crash (MVC). She suffers
from the following injuries: traumatic right temporal intracerebral hemorrhage (ICH), a traumatic
subarachnoid hemorrhage (SAH), right 3-6 rib fractures, and a right radial fracture that has been reduced
and splinted. Your patient’s VS this morning are as follows: Temp 98°F, HR 116 bpm, BP 88/54 mmHg,
RR 18 breaths/minute, Pulse ox 97% on 2 Liters/minute nasal cannula (NC). The patient has no PMH
and is no on any medication at home. Her CBC w/ Hgb 10 mg/dl and Hct 30% and BMP is WNL. Her
last narcotic was given at 11pm last night. The patient’s pain is a 5/10.
1. Your patient’s VS this morning are as follows: Temp 98°F, HR 116 bpm, BP 88/54 mmHg, RR 18
breaths/minute, Pulse ox 97% on 2 L/ min NC. Her last narcotic was given at 11pm last night.
The patient’s pain is a 5/10. You walk in to assess your patient and notice that they are difficult to
awaken. The most likely reason for this change in mental status is:
A. Wrist pain
B. Hypotension (Although pain can be a distraction this patient does not complain of significant
pain. The patient is noted to have gotten their last dose of narcotic containing medication last
night at 11pm. Hypotension can decrease cerebral perfusion resulting in a change in neurological
function and secondary brain injury in the trauma patient).
C. Narcotic overdose
CS4. An 80-yr WF is s/p MVC as rear-end and brought in to the ED via EMS. She was unconscious and
on supplemental oxygen via non-rebreather on route to the hospital. In the ED, she is attached to cardiac
monitoring with continuous pulse oximetry and a full set of VS is taken. 12-lead EKG and lab work are
quickly obtained. Then, nursing performs their head-to-toe assessment of the patient, including a full
neurologic examination.
Due to the patient’s decreased level of consciousness (LOC), the patient is unable to participate in some
aspects of the exam, so it is modified to still obtain as much information as possible. Subjective history is
limited at this time due to the patient’s mental status, and will be obtained once family is available for
interview.
The patient’s outpatient care is provided by physicians associated with the hospital and many aspects of
her medical history can be found in the electronic medical record. The patient’s pertinent PMH includes
the following:
◦ CHF w/ LVEF 35-40%
◦ CKD III (GFR 45-59)
◦ DM II with recent Hgb A1C of 7.8
◦ Chronic atrial fibrillation (A-fib)
The patient has NKDA. Her home medication list includes:
◦ Metoprolol 25 mg BID (anti-HTN, BB, ~lol, caution w/ hypoglycemia)
◦ Lisinopril 10 mg daily (anti-HTN, ACEIs)
◦ Warfarin 5 mg daily (think about rapid reversal of anticoagulation, check INR 2-3 as
target)
◦ Furosemide 20 mg daily (loop diuretics, caution w/ K, Mg, PO4)
◦ Metformin 500 mg BID (PO anti-DM: biguanides, CBC, BMP, B-12 for baseline)
◦ Glipizide 5 mg daily (anti-DM: sulfonylurea, CMP for baseline)
EMS provides the following report:
“Arrived on scene to 2 vehicle collision. Patient’s car appears to have struck the other car from behind.
The patient was found in the driver’s seat without seat belt engaged. The patient’s eyes were open and
This study source was downloaded by 100000820020768 from CourseHero.com on 04-04-2023 10:31:22 GMT -05:00
https://www.coursehero.com/file/92229205/TBI-Case-Studydocx/
and hypothyroidism is admitted with status post ground level fall (blunt injury). She is brought into the
ED on a non-rebreather via EMS.
Upon initial exam you find that the patient has a small laceration over her right eye, but no obvious signs
of skull fracture or penetrating injuries.
1. Based on this presentation the information presented on the patient and traumatic brain injuries,
what type of mechanism of injury (MOI) does she have?
A. Blunt
B. Penetrating
C. Blast
When you assess the patient, you find that she has a Glasgow Coma Scale (GCS) of 13 (E3, V4, M6) with
no focal neurological deficits. The patient has a 3mm laceration over her right eye.
2. She has a Glasgow Coma Scale (GCS) of 13 (E3, V4, M6) with no focal neurological deficits.
Which classification of brain injury does she have?
A. Mild 13-15
B. Moderate 9-12
C. Severe 3-8
The patient was diagnosed with basilar skull fracture (primary head injury) and is now complaining of a
headache and is impulsive, attempting to get out of bed despite being told multiple times that she needs to
have someone assist her when getting out of bed because of her risk of falling. She is oriented to person
and place, but not to time or situation continuing to ask to get up to let her dog out and complains that it,
“smells like rubbing alcohol in here”. When you ask her to please sit down, she smiles and gets back in
bed.
1. Your patient has a GCS of 13 and unable to stick out her tongue. What is the most likely basilar
skull fracture associated with this deficit?
A. Anterior (70% case, CN I injury, Raccoon eyes & rhinorrhea)
B. Middle (weak vault, CN II injury, Battle signs & otorrhea)
C. Posterior (uncommon, CN IX, X, XI, XII injury, clivus or occipital bone fx)
CS2. Which of the following patients is most likely to survive a penetrating head injury?
A. An 85-yr female was at the park walking her dog and was stabbed several times in
multiple areas of her head. She was found 4-hr later lethargic with unequal
pupils and minimal movement.
B. A 26-yr male suffered a self-inflicted gunshot wound to the face last night and was
found by his family this morning breathing, but not opening his eyes despite
aggressive attempts to awaken him. (less likely to survive)
C. A 42-yr man about 1 hour ago, had a witnessed ground level fall landing on a steel
rake that penetrated the left side of his head. He is awake and following commands.
This study source was downloaded by 100000820020768 from CourseHero.com on 04-04-2023 10:31:22 GMT -05:00
https://www.coursehero.com/file/92229205/TBI-Case-Studydocx/
, CS3. The patient is a 35-yr HF in the Neuro ICU status post motor vehicle crash (MVC). She suffers
from the following injuries: traumatic right temporal intracerebral hemorrhage (ICH), a traumatic
subarachnoid hemorrhage (SAH), right 3-6 rib fractures, and a right radial fracture that has been reduced
and splinted. Your patient’s VS this morning are as follows: Temp 98°F, HR 116 bpm, BP 88/54 mmHg,
RR 18 breaths/minute, Pulse ox 97% on 2 Liters/minute nasal cannula (NC). The patient has no PMH
and is no on any medication at home. Her CBC w/ Hgb 10 mg/dl and Hct 30% and BMP is WNL. Her
last narcotic was given at 11pm last night. The patient’s pain is a 5/10.
1. Your patient’s VS this morning are as follows: Temp 98°F, HR 116 bpm, BP 88/54 mmHg, RR 18
breaths/minute, Pulse ox 97% on 2 L/ min NC. Her last narcotic was given at 11pm last night.
The patient’s pain is a 5/10. You walk in to assess your patient and notice that they are difficult to
awaken. The most likely reason for this change in mental status is:
A. Wrist pain
B. Hypotension (Although pain can be a distraction this patient does not complain of significant
pain. The patient is noted to have gotten their last dose of narcotic containing medication last
night at 11pm. Hypotension can decrease cerebral perfusion resulting in a change in neurological
function and secondary brain injury in the trauma patient).
C. Narcotic overdose
CS4. An 80-yr WF is s/p MVC as rear-end and brought in to the ED via EMS. She was unconscious and
on supplemental oxygen via non-rebreather on route to the hospital. In the ED, she is attached to cardiac
monitoring with continuous pulse oximetry and a full set of VS is taken. 12-lead EKG and lab work are
quickly obtained. Then, nursing performs their head-to-toe assessment of the patient, including a full
neurologic examination.
Due to the patient’s decreased level of consciousness (LOC), the patient is unable to participate in some
aspects of the exam, so it is modified to still obtain as much information as possible. Subjective history is
limited at this time due to the patient’s mental status, and will be obtained once family is available for
interview.
The patient’s outpatient care is provided by physicians associated with the hospital and many aspects of
her medical history can be found in the electronic medical record. The patient’s pertinent PMH includes
the following:
◦ CHF w/ LVEF 35-40%
◦ CKD III (GFR 45-59)
◦ DM II with recent Hgb A1C of 7.8
◦ Chronic atrial fibrillation (A-fib)
The patient has NKDA. Her home medication list includes:
◦ Metoprolol 25 mg BID (anti-HTN, BB, ~lol, caution w/ hypoglycemia)
◦ Lisinopril 10 mg daily (anti-HTN, ACEIs)
◦ Warfarin 5 mg daily (think about rapid reversal of anticoagulation, check INR 2-3 as
target)
◦ Furosemide 20 mg daily (loop diuretics, caution w/ K, Mg, PO4)
◦ Metformin 500 mg BID (PO anti-DM: biguanides, CBC, BMP, B-12 for baseline)
◦ Glipizide 5 mg daily (anti-DM: sulfonylurea, CMP for baseline)
EMS provides the following report:
“Arrived on scene to 2 vehicle collision. Patient’s car appears to have struck the other car from behind.
The patient was found in the driver’s seat without seat belt engaged. The patient’s eyes were open and
This study source was downloaded by 100000820020768 from CourseHero.com on 04-04-2023 10:31:22 GMT -05:00
https://www.coursehero.com/file/92229205/TBI-Case-Studydocx/
