Blast Injuries Clinical Presentation (PCS) andmTBI. stress disorder(PTSD)afterablastevent,as post-traumatic post-concussion syndrome butmayactuallyhave injuries. inthepresence ofmoreacuteandlife-threatening undiagnosed Somecasesmaybe misdiagnosed duringthehospitalstay.falling debris)werenotdiagnosed CasesofmTBIfromexplosiveeventsmayremain York City, asprobable 21outof35casesretrospectively diagnosed that anddemonstrated TBI (mostlyfrom ofthe records ofsurvivors World Trade onSeptember 11, Centerattacks 2001, 36hospitalsinNew at treated tocontactsportsactivities. related explosiveeventsmimicsthat abstractedmedical following Onestudy tosevere ofmoderate While diagnosis TBI isstraightforward, ofmild underdiagnosis itislikelythat TBI (mTBI) to focalneurologicalfindings, tounconsciousness, comaanddeath. canresultinaspectrumofacute rangingfrommildconcussion,findings ofbraininjury clinical presentations resultinepiduralhematomas. that as wellbleedingfromthemiddlecerebralartery These pathological Both openandclosed skullfracturescanoccur. Bluntforceoverthetemporalareacancauseskullfractures causestearingofthebridgingveinsbetweenbrainsurface andtheduralvenoussinuses.the skullthat causecoupandcontrecoupinjuries.skull that resultfrommovementofthebrainwithin Subduralhematomas forces impactingneuronalaxonsandsmallvessels. Contusionsresultfrommovementofthebrainwithin hematomas. closed Diffuseaxonalinjuriesarecommonfollowing headinjuriesandresultfromshearing The mostcommontypesofnonpenetrating TBI arediffuseaxonalinjury, contusions, andsubdural ofgasemboli.consequent formation axonal injury). and blastmechanismcanalsoresultincerebralinfarctionduetolunginjury The primary couldpotentiallycause from theoverpressurization TBI directly(e.g., concussion, hemorrhage, edema, diffuse wave), (causedbytheoverpressurization itis. animalmodels suggestthat injury Shearandstresswaves other thanexplosions. blast Although thereissomecontroversywhetherthebrainvulnerabletoprimary isnotunlikeheadinjuriesfromcauses andblunttraumathat byblastwind)frompenetrating being thrown (causedby blastinjury andtertiary (causedbyflyingdebrisandfragments) blastinjury to bothsecondary for considerations Traumatic (TBI)inadvanceofanexplosiveevent. BrainInjury The brainisclearly vulnerable it isimportantfortheacutecareprovidertobecomefamiliarwithpathophysiology, diagnosis, andtreatment hasincreased. withbraininjury survivors Since timeisoftheessenceinclinical ofblastinjury, treatment and Afghanistan, overwhelminglyisthemostcommonwoundetiology, blastinjury andtheincidenceof inoverhalfofthosecriticallyinjuredsuchincidents.a majorinjury conflictinIraq Inthecurrentmilitary interroristbombingsandhasbeenidentifiedas Severe headtraumaisthemostcommoncauseofdeath Background • Traumatic Brain Injuries • • • • •
Extremity weaknessornumbness Disoriented, irritability, confusion Visual disturbances, tinnitus, slurredspeech Gait/balance problems, nausea/vomiting, difficulty concentrating Headache, seizures, dizziness, problems memory May ormaynotinclude oflossconsciousness history
Traumatic Brain Injuries Traumatic Brain Injuries June 2009
wordfinding), drift, motor(pronator gait/coordination)
Disposition Initial Management Acute ConcussionEvaluation • Diagnostic Evaluation weightedforidentifyingedema. lesions;diffusionweightedMRmaybeevenmoresensitivethan visualizingnonhemorrhagic T2 (FLAIR)images, T2weightedMRimages, inversionrecovery arebestforattenuated especiallyfluid foreignbodies • amnesiaoflessthan24hours theLOC (GCS)of13-15following ComaScale(GCS) Glasgow • • • • • • • • •
warrants additional follow-up andevaluation warrants additionalfollow-up persist beyondsevento10dayssuggestspost-concussionsyndrome(PCS)and Symptoms that — — — Mild inclusionTBI (CDCdefinition)–Atleast1ofthefollowing criteriapresent: Moderate toSevere Moderate TBI: GCS<12 Without further symptoms may advance through these intervals of at least24hourseach: ofat Without furthersymptomsmayadvancethroughtheseintervals Complete restuntilasymptomatic 24hoursorsoonerifsymptomsworsen every patient Re-evaluate andspecialtyreferralbasedonconditionfindings forhospitalization/transfer Consider patient Record resultsofacuteconcussionevaluation Record initialGCS, intervals appropriate andreassessat protocol Standard resuscitation MRI (notanemergency procedure)ismoresensitivethanCTindetectingdiffuseaxonalinjury. presentation, at If notasymptomatic considerCTscanforhemorrhage, cerebral contusion, fracture,
This fact sheet is part of a series of materials developedbytheCentersforDiseaseControl This factsheetispartofaseriesmaterials n eido oso osiuns LC fls hn3 iue n lso oaSae ComaScale periodoflossconsciousness(LOC)lessthan30minutesandaGlasgow Any Delayed recall: test memory namefiveobjectsfromimmediate Full duty Concentration: stringofthree, repeat four, five, andsixrandomdigits;namemonthsinreverseorder Light duty status withaerobicandresistancebutwithoutcontactactivities Light dutystatus Neurological screening: responseandtracking), eyes(pupillary verbal(speechfluency and Any alteration in mental state at thetimeofaccident(e.g., at inmentalstate alteration feelingdazed,Any disoriented, confused) beforeoraftertheaccident, oftheeventimmediately lossofmemory withposttraumatic Any Light duty status withaerobicbutwithoutresistanceorcontactactivities Light dutystatus memory: fiveobjectsread to patient Immediate threetrialsofrepeating Orientation: month, date, dayofweek, year, time and Prevention(CDC)onblastinjuries. For moreinformation, visitCDConthe Web at: www.emergency.cdc.gov/BlastInjuries.
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