University Case Study: Assessing Traumatic Brain Injury in a Patient

This case study presents a 15-year-old patient admitted to the emergency department with a traumatic brain injury. The assessment focuses on the patient's physical condition, including swelling on the right side of the brain and forehead bruises. The severity of the injury was initially evaluated using the Pediatric Glasgow Coma Scale (GCS), revealing a score of 10, indicating moderate traumatic head injury. The standard of care included serial neurological inspections, specifically pupillary assessment, which showed a normal pupil size but a sluggish reaction to light, suggesting increased intracranial pressure. Furthermore, vital signs such as blood pressure, oxygen saturation, and mean arterial pressure were assessed, highlighting hyperglycaemia and hypoxia. The case study provides detailed insights into the patient's condition and the diagnostic process, including the importance of different assessments such as pupillary response, GCS, and vital signs analysis in determining the severity of traumatic brain injury.

Running head: TRAUMATIC BRAIN INJURY
TRAUMATIC BRAIN INJURY
Name of the Student:
Name of the University:
Author note:

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Traumatic Brain injury is defined as the noncongenital and no degenerative injury to
the brain due to any external source or force that result in either temporary or permanent
damage to the brain and affect the physical, psychosocial and cognitive function of the
human body (Silver, McAllister & Arciniegas, 2018). This case scenario will focus on the 15
years old patient who had swelling in right side of their brain and also had forehead bruises
that were exhibiting the symptoms of traumatic brain injury.
The patient who was admitted to the emergency department of the paediatric unit was
suffering from traumatic head injury and the physical clinical representation only exhibited
swelling on the right side of their brain and bruised forehead, which was not enough to
determine the severity of traumatic brain injury. Hence, different vital signs examination was
conducted that would help the doctors to understand the severity of traumatic brain injury as
from the physical state it was clear that the injury took place on the right part of the brain.
The paediatric Glasgow Coma Scale (GCS) was evaluated of the patient and the score
identified was 10, which states that the patient was suffering from moderate traumatic head
injury and will lack an appropriate level of consciousness for approximately 30 minutes
(Brennan, Murray & Teasdale, 2018). Therefore, this score will enable the healthcare
providers to understand the survival level of the patient.
The standard of care considered optimal for the patient suffering from traumatic brain
injury comprise of serial neurological inspection that majorly includes pupillary assessment,
which is performed by the trauma nurse. This test will help the healthcare professional to gain
knowledge regarding the progression and severity of the brain injury associated with the
function of brainstem (Williams, 2018). The diameter of the pupil is very crucial for
identifying the damage caused to the nervous system of the patient as the diameter of iris is
managed and controlled by 2 different muscles namely pupilloconstrictor that symbolise for
the sphincter muscle controlled by parasympathetic nervous system (PNS) and pupillodilator

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that is controlled by the sympathetic nervous system (SNS) (Pavlovic et al., 2019). The
standard pupil diameter for the older children is considered to be amongst 2-5 mm and in this
scenario, the patient exhibited the pupil size of 4 mm, which was considered normal and
exhibited that no severe damage took place in the activity of sympathetic and
parasympathetic nervous system. The pupillary assessment also comprises of reporting the
reflex of the pupil in response to direct light. The light will be directed straight to the patient
pupil and the reaction will be reposted that will help the healthcare provider to identify the
level of intracranial pressure (ICP). The patient exhibited sluggish reaction towards the direct
light that indicated that the patient had increased intracranial pressure (ICP) and if not treated
timely might result in non-reactivity of light and server intracranial pressure (ICP). Therefore,
the complete pupillary assessment exhibited that the patient was suffering form moderate
traumatic brain injury and required immediate care that would help him to reduce the
intracranial pressure and enhance the reactivity towards light (Kramer et al., 2019).
The neurological and pupillary assessment of the patient had helped the healthcare
professionals to determine the severity of the injury and the location, which will be further
examined by assessing other vital sigs of the patients such as heart rate, blood pressure,
respiratory rate, spo2 and mean arterial pressure (MAP) (Roberts et al., 2019). From the vital
signs examination it was clear that the patient was exhibiting the condition of
hyperglycaemia, as the blood pressure of the patient was high. The brain injury result in
hormonal imbalance and sympathetic response that occurs immediately after the injury and is
directly related to the severity of the injury and the poor outcome of the patient. Since, the
patient exhibited the blood glucose level of 138/49, it was noted that the patient had moderate
level of head injury. The level of oxygen present within the patient was low than the standard
value exhibiting Spo2 as 94% leading to the condition of hypoxia. Since the patient had the
hypoxia condition it was highly possible that the blood vessel will dilate that will in turn

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increase the blood flow into the brain leading to high intracranial pressure the will affect the
pupil reaction and the patient might lose their eye sight (Santiago et al., 2018). The mean
arterial pressure (MAP) of the patient was under normal range that therefore reduces the
possibility of blood clot or any severe damage to the great muscles resulting in heart attack or
kidney failure. It was further noted that the heart rate and respiratory rate of the patient was
normal and under the standard value that therefore reduced any risk of heart failure in the
patient.
Therefore from the complete assessment of the patient it was evident that the patient
was suffering from right-sided moderate traumatic brain injury and was under no risk of heart
attack or kidney failure and based on the classification of traumatic brain injury, moderate
traumatic brain injury was identified in the patient that would require complete care and
treatment.

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References
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information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended
index of clinical severity. Journal of neurosurgery, 128(6), 1612-1620.
Kramer, A. H., Couillard, P. L., Zygun, D. A., Aries, M. J., & Gallagher, C. N. (2019).
Continuous Assessment of “Optimal” Cerebral Perfusion Pressure in Traumatic Brain
Injury: A Cohort Study of Feasibility, Reliability, and Relation to Outcome.
Neurocritical care, 30(1), 51-61.
Pavlovic, D., Pekic, S., Stojanovic, M., & Popovic, V. (2019). Traumatic brain injury:
neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary, 22(3),
270-282.
Roberts, B. W., Kilgannon, J. H., Hunter, B. R., Puskarich, M. A., Shea, L., Donnino, M., ...
& Shapiro, N. I. (2019). Association between elevated mean arterial blood pressure
and neurologic outcome after resuscitation from cardiac arrest: results from a
multicenter prospective cohort study. Critical care medicine, 47(1), 93-100.
Santiago, C. B., Augusto, R., Maeda, F. L., Ghizoni, E., & Fernandes Joaquim, A. (2018).
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Intensiva y Emergencias, 17(S2), 7-11.
Silver, J. M., McAllister, T. W., & Arciniegas, D. B. (Eds.). (2018). Textbook of traumatic
brain injury. American Psychiatric Pub.
Williams, A. L. (2018). Traumatic brain injury. Physical Management for Neurological
Conditions E-Book, p153.