There is limited data on TBI in animals. Anticipate TBI in MWDs after trauma in 25-40% of cases.2-6 TBI carries an extremely high mortality; assume a prehospital mortality of >40% in severe TBI cases. Management of MWDs is largely based on recommendations for treating people. Care by HCPs should be directed at efforts to mitigate secondary injury from hypotension, hyperthermia, hyper- and hypoglycemia, hypoxia, hyper-and hypocapnia, acid-base imbalances, electrolyte imbalances, SIRS, MODS, and ARDS. Thus, HCP care should be directed at maintenance of blood pressure, normoxemia, normal ventilation, and normal body temperature.
Clinical Signs Suggesting TBI
Brain injury should be suspected in any trauma patient with altered mentation (coma, stupor, depression, lethargy, inappropriate behavior or responses) or with physical evidence of head trauma (e.g., lacerations, abrasions, bruising, swelling, pain, bleeding from the nose or ears).
- Pay special attention to the patient‘s level of consciousness (LOC), overall pain response, pupillary light responses, cardiac and respiratory changes, motor activity and reflexes, and body temperature.
- The external ear canals and nasal openings should be examined for evidence of blood or CSF.
- The presence of lateralizing neurologic signs in a patient with brain injury suggests underlying intracranial hemorrhage; whereas patients with diffuse CNS deficits more probably have significant intracranial edema as a cause or contributor to their neurologic dysfunction.2-5 These findings will affect treatment options.
- MWD posture on presentation may allow injury localization and estimation of prognosis. While these classic postures are not always noted, their presence can be used by first responders to identify severe TBI with poor-to-grave prognoses.
- Patients with injury to the T2-L2 thoracic spine often display the Schiff-Sherrington syndrome (Figure 47, inset A), typically with normal mentation, forelimbs in extensor rigidity, and hind limbs that are flaccid. The prognosis for these patients is usually grave due to severe spinal cord trauma.
- Patients with decerebellate rigidity (Figure 47, inset B) typically are obtunded or depressed, have opisthotonus, have fore limbs in extensor rigidity, and hind limbs in active flexion. These patients have a guarded prognosis due to severe injury to the cerebellum.
- Patients with decerebrate rigidity (Figure 47, inset C) typically are obtunded, have opisthotonus, and the fore limbs and hind limbs are in extensor rigidity. The prognosis for these patients is grave due to severe injury to the cerebrum.
Figure 47. Characteristic Neurologic Postures on Presentation