Risk Management Pitfalls For Severe Traumatic Brain Injury
“The patient was in a car crash and had an obvious femur fracture. I didn’t think he needed a point-of-care glucose, given the obvious trauma.”
All patients with altered mental status must have point-of-care blood glucose testing. Hypoglycemia and hyperglycemia can cause altered mental status, and they are easily reversible with treatment. In patients with a severe TBI, hyperglycemia or hypoglycemia may worsen neurologic outcomes if it is not urgently addressed.
“The patient smelled of alcohol and was obviously intoxicated.”
Over 60% of all severe TBIs are complicated by alcohol or drug intoxication, which may worsen morbidity. Blood alcohol levels and urine toxicology screens may help prove concomitant intoxication, but based on available history and physical examination, a patient should be aggressively resuscitated for severe TBI.
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