Failure to Diagnose & Delay in Treatment of Head Injury

Evaluate breaches in the standard of care when determining a Failure to Diagnose & Delay in Treatment of Head Injury

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following types of head injury did the patient present? (Choose all that apply)
    Severe / moderate head injuries
    Minor head trauma
    Penetrating head injuries (gunshot wounds)
    Answer unknown
    Why is this important?
    Minor head trauma is an injury to the brain resulting in a temporary and brief interruption of neurologic function after head trauma, which may involve a loss of consciousness (LOC).
    Click here for additional information at ClinicalKey.com

  • Was the patient’s Glasgow Coma Score (GCS) assessed? Why is this important?
    Answer this question
    The standard internationally accepted measurement of consciousness is the Glasgow Coma Scale (GCS), in which patients are awarded points based on eye opening, best verbal response, and best motor response.
    Click here for additional information at cdc.gov.com

  • Upon presentation, what was the patient’s GlasgowComa Score (GCS)? Why is this important?
    Answer this question
    The patient's initial GCS score should be recorded and used as a baseline; the GCS score should be re-determined regularly to ensure that the patient's level of consciousness is not diminishing.
    Click here for additional information at ClinicalKey.com

  • Was oxygen administered? Why is this important?
    Answer this question
    Oxygenation is provided once the patient's airway has been secured, starting at a 100 percent concentration.
    Click here for additional information at ClinicalKey.com

  • Was the patient’s spine immobilized? Why is this important?
    Answer this question
    Stabilization of the cervical spine, particularly before transfer, until imaging studies confirm that the patient has not sustained a cervical spine injury, is necessary.
    Click here for additional information at ClinicalKey.com

  • Which of the following pre-hospitalization treatment modalities were provided? Why is this important?
    Answer this question
    Valuable pre-hospital care including a head to toe examination, continuous monitoring, placement of subsequent intravenous access, and environmental control can be provided while the patient is being transported.
    Click here for additional information at ClinicalKey.com

  • Did the Emergency Medical Services (EMS) personnel transport the patient to a trauma center? Why is this important?
    Answer this question
    Patientssuspectedto have a head injury need tobe transported to atrauma center.
    Click here for additional information at cdc.gov.com

  • Which of the following signs of increased Intra-Cranial Pressure (ICP) did the patient experience?(Choose all that apply) Why is this important?
    Answer this question
    Symptoms of increased ICP include vomiting, syncope, altered mentation, bradycardia, increased blood pressure and irregular respirations.A unilaterally dilated pupil or an unreactive pupil is a late sign of cerebral herniation and is a clear indicator of elevated intra-cranial pressure.
    Click here for additional information at ClinicalKey.com

  • Was a medical history obtained? Why is this important?
    Answer this question
    The diagnosis is often clear from the history provided by individuals who witnessed the trauma. However, in patients who are found unconscious with no available history, a cardiovascular or a metabolic cause for the unconsciousness must be excluded. Past medical history, medications (particularly anticoagulants), recent drug or alcohol use, and complaints immediately before the traumatic event should be investigated.
    Click here for additional information at ClinicalKey.com

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
    Click here for additional information at ClinicalKey.com

  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Patients with mild traumatic brain injury (mTBR) can present with a cluster of symptoms.
    (2007) 109 ECLNEU 5 399-405

  • Was the patient kept under observation? Why is this important?
    Answer this question
    In low-risk patients with mild traumatic brain injury (mTBR), a close observation is advised in the ED for 4 to 6 hours. If there is no deterioration and physical examination was normal the patient can be discharged safely from the ED.
    (2007) 25 EMDCNA 3 655-678

  • Which of the following rehabilitation treatment methods were prescribed?(Choose all that apply) Why is this important?
    Answer this question
    Neuromuscular exercise program under trained supervision is recommended to assist patients in regaining their mobility, independence, and ability to perform activities of daily living after severe neurologic trauma.
    Click here for additional information at ClinicalKey.com

  • Which of the following complications did the patient develop?(Choose all that apply) Why is this important?
    Answer this question
    The complications after head injury can be broadly classified as neurologic complications (Seizures, central nervous system infections), medical complications, specific injuries (scalp wounds, skull fractures, diffuse axonal injury, cerebral contusions, epidural hematoma, subdural hematoma, subdural hygroma, traumatic subarachnoid hemorrhage, intracerebral hematoma, traumatic intercerebellar hematoma).
    Click here for additional information at ClinicalKey.com

  • Were the complications managed? Why is this important?
    Answer this question
    Post traumatic seizures are common, especially in children and can be precipitated by relatively minor head injury. Antiepileptics, such as phenytoin , fosphenytoin , and levetiracetam , are used in patients with seizures or prophylactically in select unstable patients who are at high risk for seizures and in whom seizure activity may increase morbidity or mortality.
    Click here for additional information at ClinicalKey.com

  • Were discharge instructions provided? Why is this important?
    Answer this question
    Patients should be discharged with instructions describing the signs and symptoms of delayed complications of head injury, should have access to a telephone, and should be monitored in the acute post-trauma period by a responsible, sober adult.
    Click here for additional information at ClinicalKey.com

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
    Click here for additional information at ClinicalKey.com

  • Was the patient intubated? Why is this important?
    Answer this question
    Intubation and ventilation may be necessary if the patient presents with a low GCS (Glasgow Coma Scale) score.
    Click here for additional information at ClinicalKey.com

  • Was the patient intubated? Why is this important?
    Answer this question
    One of the primary goals of pre-hospital trauma care is maintaining control of the injured patient's airway. The gold standard for airway maintenance in severely injured patients remains oral endotracheal intubation, typically using a rapid-sequence technique with spine stabilization.
    Click here for additional information at ClinicalKey.com