scholarly journals Glasgow in Maxillofacial Fractures Patients: Mini Review

2020 ◽  
Vol 5 (6) ◽  
pp. 1579-1581
Author(s):  
Giovanna Franchi Cascarani ◽  
Enrico Affonso Barletta ◽  
Daniela Prata Tacchelli
Keyword(s):  
Glasgow Coma Scale ◽  
Brain Injuries ◽  
Altered Mental Status ◽  
Maxillofacial Trauma ◽  
Common Mechanism ◽  
Coma Scale ◽  
Vehicle Accident ◽  
Maxillofacial Fractures ◽  
Male Patients ◽  
Mechanism Of Trauma

Background: Maxillofacial traumas are the most frequent one, and are usually associated with brain injuries that can be measured by the Glasgow Coma Scale (GCS).Material and Methods: We did a mini review of the literature using PubMed as our data base, using “maxillofacial trauma and Glasgow Coma Scale” as key words. Among 73 articles found, we selected 3 articles that together analyzed 213 patients. Results: It was found that male patients (77,4%) were more affected than female (22,5%), the average age was 34,6 ±8,32 years, and the most common mechanism of trauma was vehicle accident. Just 10 patients presented a score between 14 and 15 on the GCS, which showed that most patients had neurological damage in different degrees.Conclusions: It was found that there is a relation between maxillofacial trauma and a decreased level of consciousness. Although, the literature lacks of studies analyzing the relation and presence of an altered mental status and the occurrence of a maxillofacial trauma.

scholarly journals Altered Mental Status and a Retro-auricular Mass

2006 ◽  
Vol 33 (3) ◽  
pp. 317-319
Author(s):  
Lauren M. Segal ◽  
Angela Walker ◽  
Eric Marmor ◽  
Errol Stern ◽  
Mark Levental ◽  
...  
Keyword(s):  
Eye Movements ◽  
Glasgow Coma Scale ◽  
Emergency Room ◽  
Mental Status ◽  
External Auditory Canal ◽  
Posterior Wall ◽  
Altered Mental Status ◽  
Facial Paresis ◽  
Coma Scale ◽  
History Of

A 29-year-old woman was found lying unconscious in the shower. There was a two-day history of headache and dizziness. In the emergency room, she was initially stuporous (Glasgow Coma Scale 10/15), afebrile, bradycardic and hypertensive. She exhibited roving, conjugate eye movements, left facial paresis (including frontalis), left ptosis, diffuse hypotonia, extensor plantar responses bilaterally and a 1.5 cm warm, fluctuant mass with surrounding erythema behind the left ear (Figure 1). Otoscopy revealed a bulge in the posterior wall of the left external auditory canal.

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

Trauma: Multisystem Injury

2018 ◽  
pp. 87-94
Author(s):  
Dion M. McCall ◽  
Molly Amin ◽  
Michal Gajewski
Keyword(s):  
Glasgow Coma Scale ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Postoperative Management ◽  
Open Reduction Internal Fixation ◽  
Coma Scale ◽  
Vehicle Accident ◽  
Trauma Injury

In this chapter the essential aspects of anesthesia for multisystemic trauma injury are explored. The patient in the case requires open reduction internal fixation of a closed right humerus fracture sustained in a motor vehicle accident. Subtopics discussed include the Focused Assessment by Sonography in Trauma (FAST) survey, Glasgow Coma Scale, massive blood transfusion protocol, and shock. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Topics related to preoperative evaluation include assessment using the FAST survey and Glasgow Coma Scale. Intraoperative topics include anesthetic management and dealing with shock and other complications. Postoperative management is also discussed.

The use of recombinant activated factor VIIa in coagulopathic traumatic brain injuries requiring emergent craniotomy: is it beneficial?

2009 ◽  
Vol 111 (4) ◽  
pp. 666-671 ◽  
Author(s):  
Nathaniel McQuay ◽  
James Cipolla ◽  
Eleanor Z. Franges ◽  
Gregory E. Thompson
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Factor Viia ◽  
Factor Vii ◽  
Common Mechanism ◽  
Thromboembolic Events ◽  
Coma Scale ◽  
Severe Tbi

Object The role of recombinant activated factor VII (rFVIIa) in traumatic brain injury (TBI) has not been well established. This study evaluates the outcomes of using rFVIIa as first-line therapy in patients with a severe TBI requiring emergent craniotomy that are coagulopathic. Methods The authors retrospectively reviewed patients admitted between 2003 and 2006 to a Level I trauma center with a severe TBI requiring an emergency craniotomy. Eighteen patients with coagulopathy that was corrected using rFVIIa were identified. Variables evaluated included age, injury severity score, head abbreviated injury score, Glasgow Coma Scale score, international normalized ratio, time to operation, operative procedure, thromboembolic events, and death. Results The cohort consisted of 18 patients, predominantly male (55.6%) with a mean age of 80.5 years. The most common mechanism of injury was a fall. Coagulopathy was due to premorbid anticoagulants in 50% of the cohort. Time from admission to operation was 130 minutes. Coagulopathy reversal was complete in all 18 cases (100%). A high mortality rate (55.6%) was attributed to a high incidence of withdrawal of care (50%). The incidence of thromboembolic events was low (5.6%). Survivors, when compared with nonsurvivors, had a > 3-fold increase in postoperative Glasgow Coma Scale score for similar preoperative scores. A good functional outcome was achieved in 75% of survivors with a mean follow-up period of 4.2 months. Conclusions The use of rFVIIa in the correction of coagulopathy in patients having sustained severe TBI requiring emergency craniotomy appears to be safe and effective even among the elderly. This allows a shorter transit time to craniotomy. Its effects on mortality and long-term neurological outcome requires further investigation prospectively.

scholarly journals In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

2011 ◽  
Vol 19 (6) ◽  
pp. 1337-1343 ◽  
Author(s):  
Cristina Helena Costanti Settervall ◽  
Regina Marcia Cardoso de Sousa ◽  
Silvia Cristina Fürbringer e Silva
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Brain Injuries ◽  
Predictive Ability ◽  
Traumatic Brain Injuries ◽  
Receiver Operator Characteristic ◽  
Coma Scale ◽  
Initial Care ◽  
Predict Hospital Mortality ◽  
Severity Levels

This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scale’s predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instrument’s moderate discriminatory power.

scholarly journals Brainstem Diffuse Axonal Injury and Consciousness

2019 ◽  
Vol 9 ◽  
pp. 32 ◽  
Author(s):  
Sukhwinder Sandhu ◽  
Erik Soule ◽  
Peter Fiester ◽  
Patrick Natter ◽  
Daryoush Tavanaiepour ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Brain Injuries ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Prognostic Indicator ◽  
Coma Scale ◽  
Vehicle Accidents ◽  
Neurological Outcomes ◽  
Neurological Injuries

Background: Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury. Methods: MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries. Results: Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14–15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons. Conclusion: These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.

scholarly journals Difference and efficacy of simplified motor scale compared to Glasgow coma scale

2021 ◽  
Author(s):  
Tammam Mozher Aldarwish ◽  
Mohammed Abdulaziz Alowaidhi ◽  
Naish Abdullah Alghamdi ◽  
Ahmed Mohammed Al Hammad ◽  
Mohammed Ibrahim Aljikhlib ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Test Performance ◽  
Brain Injuries ◽  
Pediatric Patients ◽  
Functional Performance ◽  
Motor Score ◽  
Coma Scale ◽  
Prediction Of Mortality ◽  
Gcs Score ◽  
Performance Results

There have been many limitations reported with using the Glasgow coma scale (GCS), including complexity, and being difficult to apply among aphasic, intubated, and pediatric patients. Accordingly, many researchers exerted serious efforts to enhance and modify the scale to make it more applicable and easy to interpret in these settings. The simplified motor score (SMS) was reported in the literature in 2012 for the assessment of patients with coma in different traumatic and non-traumatic settings. In the present study, we have discussed the findings of previous studies in the literature that compared the efficacy between the SMS and GCS in the assessment of patients with traumatic brain injuries within the emergency department and out-patient settings. Our results indicate the efficacy of the SMS is similar to that of the GCS score in predicting the different outcomes, including functional performance, need to perform tracheal intubation and hospital admission. Nevertheless, evidence regarding the prediction of mortality seems to be inconsistent across the different investigations. However, the differences between the two scores is not remarkable among these studies, indicating that the SMS is an efficacious tool in this regard within an acceptable test performance results. Furthermore, the SMS score can be easily applied within these without performing complex approaches, which makes it more advantageous than the GCS. However, this evidence is based on a limited number of investigations, and more studies are required.

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