Disability

Written on 10/10/2024
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Disability and Neurological Assessment

 

1. Pupil Examination

  • Size and Reactivity
  • Shape

 

2. Glasgow Coma Scale (GCS)

Classification of Head Injury Severity:

  • Mild Head Injury: GCS 13–15
  • Moderate Head Injury: GCS 9–12
  • Severe Head Injury: GCS 3–8

 

Possible causes of low GCS:

i. Impaired Cerebral Perfusion:

  • Hypotension leading to reduced blood flow to the brain.

ii. Cerebral Injury:

  • Traumatic brain injury (TBI), including contusions, hemorrhages, or diffuse axonal injury.

iii. Hypoglycemia:

  • Low blood glucose levels affecting brain function.

iv. Substance Influence:

  • Alcohol, narcotics, or other drugs causing CNS depression.

 

3. Lateralizing Signs

  • Definition: Physical signs indicating that one side of the brain is affected.
  • Examples:
    • Weakness or paralysis on one side of the body (hemiparesis or hemiplegia).
    • Unequal reflexes.
    • Sensory deficits.

 

4. Spinal Cord Injury Assessment

Signs suggestive of acute traumatic spinal cord injury:

  • Loss of reflexes
  • Loss of motor control
  • Flaccid paralysis
  • Hypertonia.

 

5. Management of Severe TBI (GCS ≤ 8)

Patients with severe TBI require prompt interventions to minimize secondary damage.

 i. Definitive Airway Management.

  • Endotracheal Intubation

ii. Elevate the head of the bed to 30 degrees.

  • Facilitates venous drainage from the brain, reducing ICP.

 iii. Early removal of rigid cervical collar

  • Remove the rigid cervical collar as soon as spinal injury is ruled out to improve venous return.

 iv. Maintain MAP 80–90 mmHg

  • Ensures adequate cerebral perfusion pressure (CPP).
  • CPP = MAP – ICP; maintaining MAP helps offset elevated ICP.

 v. Adequate sedation and analgesia

  • Reduces metabolic demands of the brain & prevents agitation that can increase ICP.

vi. Strict glycemic control:

  • Target: 4–10 mmol/L
  • Maintain normoglycemia to optimize brain metabolism.

vii. Maintain PaCO₂ between 35–40 mmHg.

  • Avoid hyperventilation, which can cause cerebral vasoconstriction and reduce cerebral blood flow.

viii. Seizure Prophylaxis

  • Phenytoin administration reduces the risk of post-traumatic seizures.

ix. Consider for Mannitol / Hypertonic Saline:

  • Evidence of raised ICP (e.g., deteriorating GCS, pupillary changes).