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Here are the clinical definitions and recommended Tx's....CIVILIAN WORLD!!!– Traumatic Brain Injury’s: Concussion
– Mild (grade 1)
confusion with no amnesia or loss of consciousness
– Moderate (grade 2)
confusion with amnesia, no loss of consciousness
– Severe (grade 3)
– any loss of consciousness
– Other nomenclature system
– mild :concussion
at least one of these
– any LOC
– any amnesia
– any altered mental status
– any focal neurological deficit
– +/- transient symptoms
– moderate
+ LOC with prolonged confusion
– physical and/or cognitive and/or behavioral impairments
• +/- permanent
– severe
coma/LOC: variable time
– likely permanent disabilities
Define the Treatments
Grade 1 (confusion with no amnesia or LOC)
– if confusion clears within 20-30 minutes, than allow return to activity OR within 1 week of being without symptoms
– after a 2nd mild concussion in the same 6 month period, do not return to activity that may lead to another concussion for 2 weeks
must be asymptomatic at least 1 week and have a negative CT scan
– if a third mild concussion occurs, terminate risky activities for the year
may return next year if asymptomatic
– (?) neuropsychology evaluation
Define the Treatments
Grade 2 (confusion with amnesia, no LOC)
– return to activity only after appropriate evaluation (CT scan, +/- neuropsych eval.) and asymptomatic for 1 week
– after 2nd moderate concussion, return to activity only after asymptomatic for 1 month and CT documented as normal
– if a 3rd occurs, terminate the activity for 1 year and consider termination of contact sports or other ‘high risk’ activities indefinitely
Define the Treatments
Grade 3 (any LOC)
– urgent transport to trauma center
– may return to activity after asymptomatic for at least 2 weeks
if LOC was < 1 minute and CT normal
– if LOC > 1 minute
no return to high risk activity for 1 month and must be asymptomatic for at least 2 weeks
– if second episode LOC, terminate contact sports/high risk activity indefinitely
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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