I would agree with JM here - and Boy do we have a lot of experience.
John Ryan hasn't mentioned the drunk who kept looking into all the cubicles
before "going to ground" some hours later - with bilateral extra-durals!!
I try to keep all of them under supervision for some hours - if lifting
their GCS level to normal and staying there - skull x-ray to ensure no
fracture (presence of fracture raises risk of haematoma so much that CT
essential). If no lifting of GCS level - CT - usually between 8 am and
9am, as so many come in at night. If GCS falls - CT ASAP.
No matter what we do, we'll miss some - aim is to balance between risk and
resource availability. In addition, I would not want to continually CT our
"Skid-row" types, because of the long-term radiation issues.
PKP
-----Original Message-----
From: Jonathan Marrow [mailto:[log in to unmask]]
Sent: 30 September 2001 16:28
To: [log in to unmask]
Subject: Re: why is GCS down?
AF
Basically concussion and contusion etc preferentially affect cognition and
lucidity, leading to loss of both short and long term memory and clouding of
consciousness. Alcohol on the other hand preferentially produces cerebellar
signs; ataxia, dysarthria and nystagmus. Alcohol will affect only short term
memory with no affect on long term memory. Also the gcs dramatically varies
from minute to minute with alcohol but is more stable with head injury.
JM
Thanks for that. I am sure the distinctions you mention are correct but
feel uncomfortable to use them as criteria for discharge. The apparently
intoxicated mild head injury is surely the patient to be watched until they
wake up, with readiness to CT if they deteriorate instead. The patient who
is similarly obtunded but fits the picture you give for concussion/contusion
warrants earlier CT...is that your practice?
Cheers
Jonathan Marrow
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