Learning Objectives
- Recognize the signs and symptoms of a traumatic brain injury (TBI) and its complications.
- Differentiate a mild TBI from a neurosurgical emergency.
- Apply initial management principles and patient monitoring.
- Determine evacuation and transport criteria in both prehospital and remote settings.
Scenario 1: Karate Tournament – Severe TBI in a Sports Context
Context
You are attending a karate tournament where an athlete has received a blow to the head. He was removed from the match and given time to rest. Fifteen minutes later, his symptoms appeared to subside. However, he suddenly begins complaining of increasing cranial pressure and wants to lie down. After a few minutes of observation, his condition rapidly deteriorates, and he becomes unconscious with a Glasgow Coma Scale score of 9 (2-2-5).
Available Information
| Vital Signs | Values |
|---|---|
| Pulse | 56 bpm |
| Respiration | 32, irregular with apnea pauses |
| Blood Pressure | 184/86 mmHg |
| Oxygen Saturation | 95% on room air |
| Blood Glucose | 5.2 mmol/L |
Validation Questions
- What condition do you suspect?
- What is the indicated treatment?
- Is relative hyperventilation recommended? Under what parameters?
- What is the name of the irregular breathing pattern with apnea pauses following a TBI?
Critical Points and Challenges
- Identifying signs of impending brain herniation.
- Applying appropriate airway management and ventilation.
- Determining the need for rapid transport to a neurosurgical center.
Scenario 2: Remote Hiking Trip – Mild TBI Under Observation
Context
You are on a week-long hiking expedition with a group of young participants. On the third day, one of them complains of headaches, dizziness, nausea, and a feeling like in a fog. Upon assessment, he recalls hitting his head on a rock while playing in the water currents the day before. Since he felt fine afterward, he did not mention it. He is oriented to person, place, and time, and his vital signs are stable.
Available Information
| Vital Signs | Values |
| Pulse | 84 bpm |
| Respiration | 18 rpm |
| Radial Pulse | Present |
Validation Questions
- What are the four domains of signs and symptoms for a mild TBI?
- What skull fracture signs may appear hours after trauma?
- Can this patient continue the activity with the group? If not, what is your evacuation plan?
- What follow-up is recommended for the next few days?
Critical Points and Challenges
- Differentiating a mild TBI from a major TBI.
- Evaluating return-to-activity criteria and monitoring needs.
- Organizing an evacuation in a remote area if necessary.
Conclusion and Key Takeaways
- A TBI may initially appear stable but deteriorate rapidly, requiring strict monitoring.
- Signs of brain herniation must be identified quickly for effective management.
- Managing a TBI in a remote environment involves prolonged monitoring and appropriate evacuation criteria.
- Recognizing delayed signs of skull fractures is essential for directing further care.
These case studies aim to stimulate clinical reflection and enhance decision-making skills in emergency situations.
We hope you enjoyed these case studies and don’t hesitate to contact us by email (info@smiq.ca) or on our social medias if you have any questions or would like to know the answers to the previous questions!
