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Traumatic brain injury survival chanches.
Geriatrics & Rejuvenation
Question #10443
2 hours ago
13

Traumatic brain injury survival chanches. - #10443

Anett

My mother fell and hit her head. I would be thankful for any information about the possible outcomes of this situation. I composed a summary with AI based on her current medical records and if needed I can provide the actual documents. Here is the summary: . Initial Event and Prehospital Care 22 Feb 2026, ~13:00: Fell ~1.5 m down stairs at home while intoxicated; lay unconscious ~30 min before ambulance call. Ambulance arrival 13:35: GCS 1–2–5. Bleeding from ears, nose, mouth. Pupils isocoric, sluggish; sats 88%. BP ranged 149/106 → 108/81. Blood glucose 9.5 mmol/L. Interventions: High-flow O₂, bilateral nasopharyngeal airways, peripheral IV, tranexamic acid 1 g, ketamine 160 mg, succinylcholine 160 mg, additional ketamine 40 mg. RSI intubation at 14:20 (Cormack I). Bagged then ventilated (IPPV, FiO₂ 1.0, VT 550 mL, PEEP 5). Immobile with C-spine collar, spine board, warming blankets. Transfer: Arrived at BAZ Megyei Kórház, Miskolc, 15:29, intubated and ventilated. EMS diagnosis: unconsciousness (R4020), alcohol intoxication (Y9190), head contusion (S0710). 2. Emergency Department (22 Feb 2026) Initial condition: Intubated, ventilated; GCS 1T1. RR 137/97, pulse 83. Pupils isocoric, sluggish. Persistent bleeding from right ear, nose, oropharynx. No chest/abdominal trauma. EtOH level: 391 mg/dL (3.91‰). Labs (14:58 sample): Hb 138 g/L, WBC 9.58 G/L, PLT 220 G/L, INR not obtained (sampling error). AST 47 U/L, GGT 58 U/L, LDH 507 U/L, creatinine 51 µmol/L, glucose 6.5 mmol/L. CT (head, cervical spine, chest) 15:49: Right occipital epidural hematoma 14 mm thick. Left fronto-parietal acute subdural hematoma 7 mm. Left fronto-temporo-basal contusions (5–15 mm). Right cerebellar hemorrhagic contusions (10–15 mm). Small traumatic subarachnoid hemorrhage in left frontal sulci. Skull fractures: right occipital (extending to base); displaced left zygomatic arch fracture; left frontal sinus anterior/lateral wall fractures with impaction; left lateral orbital wall fracture with impaction; small orbital floor fracture. No cervical spine fracture. Chest: tracheal tube in place. Mild dorsal atelectasis; no pneumothorax, no fractures. Neurosurgery consult (15:34, Dr. Molnár): Status: GCS 1T1, intubated, no pupillary reaction, no response to pain. Diagnoses: right occipital epidural hematoma, left frontal subdural hematoma, frontal and cerebellar contusions, right occipital skull fracture. Plan: ICU monitoring, repeat CT/consult next day. No immediate surgery. Ultrasound (abdomen/pelvis) 15:33: Solid organs normal; no free fluid; bladder not evaluated due to catheter. Chest X-ray 22 Feb 18:55: ET tube and left CVC well positioned. Small linear atelectasis left lung; no pneumothorax. 3. ICU Course and Subsequent Events Laboratory trends: 22 Feb 21:00 – Coagulation: PT 10.7 s, INR 0.95, APTT 33 s, fibrinogen 2.6 g/L. 23 Feb 05:00 – CBC: WBC 8.39 G/L, Hb 107 g/L, RBC 3.05 T/L, PLT 176 G/L. Procalcitonin 0.03 ng/mL, CRP <4 mg/L. APTT 62.3 s with heparin effect, normal after heparinase. Thrombin time 55.7 s due to heparin; normalized after treatment. NT-proBNP 168 pg/mL. Urinalysis: blood positive, otherwise normal. 23 Feb 07:16 – Serum magnesium 0.63 mmol/L. Repeat Head CT (23 Feb 11:50): Progression of left frontal intraparenchymal hematoma (~5 cm) with surrounding edema, compression of left lateral ventricle, midline shift 9 mm to the right. Other hemorrhages unchanged. Neurosurgical consult (23 Feb 15:34, Dr. Czabajszki): GCS 1T4. Pupils small, non-reactive. Localization/flexion to pain only on right; left-sided movement absent. Diagnoses: progression of left frontal contusion/hematoma, persistent SDH, cerebellar contusion, occipital fracture. Recommendation: urgent right frontal ventricular drain, followed by left frontoparietal craniotomy to evacuate subdural and intraparenchymal hematomas (performed same day). Procedures (23 Feb): 17:20 – Right frontal ventriculostomy (Kocher point) with drain placement, high-pressure hemorrhagic CSF noted. 18:00–19:40 – Left frontoparietal craniotomy with evacuation of acute subdural hematoma and left frontal intracerebral hematoma; subdural and subgaleal drains placed; bone flap replaced; Surgicel applied; drains connected to suction. CSF analysis (23 Feb 20:20, via ventricular drain): Appearance: bloody, cleared after centrifugation. WBC 3203/µL (86% polymorphonuclear). RBC 1.183 T/L. Protein >20,000 mg/L. Glucose 2.3 mmol/L. Gram stain: cell-rich smear, neutrophil predominant; bacteria not clearly seen. (Interpretation in chart: bacterial meningitis, culture results not documented.) Labs 24 Feb 05:00: WBC 11.21 G/L, neutrophils 82%, lymphocytes 13.6%. RBC 2.51 T/L, Hb 88 g/L, Hct 0.24, PLT 152 G/L. CRP 49.9 mg/L, Procalcitonin 22.11 ng/mL. NT-proBNP 126 pg/mL. Renal function normal (urea 3.2 mmol/L, creatinine 50 µmol/L). Interpreted as severe sepsis and anemia; heparin effect resolved. 4. Current Status (as of last records, 24 Feb 2026) Intubated and mechanically ventilated in KAITO (central ICU). Right frontal external ventricular drain in place; left cranial drains (subdural, subgaleal) with suction bottles. Neurological exam (23 Feb postoperatively): GCS 1T4; pupils bilaterally small, non-reactive; withdraws to pain on right side, minimal/no movement left. No updated exam documented after 23 Feb. Diagnoses documented: Severe traumatic brain injury with multi-compartment hemorrhage. Postoperative state after ventricular drainage and left frontoparietal craniotomy with hematoma evacuations. Bacterial meningitis (per CSF results). Severe sepsis (per labs). Post-traumatic anemia (Hb 88 g/L). History of liver cirrhosis, chronic alcoholism, heavy smoking. Multiple skull and facial fractures as noted above. No abdominal or pelvic injuries on imaging; chest imaging shows only mild atelectasis. 5. Outstanding Issues / Data Gaps No culture results (blood, CSF) or antibiotic regimen listed in provided documents. No repeat neurological exam, ICP readings, or CT imaging beyond 23 Feb. No hemodynamic details or sedation regimen included. No coagulation studies after 24 Feb sample. No documentation of nutritional support, ventilator settings post-ED, or organ function trends beyond labs noted.

Age: 49
Infection
Surgery
Injury
Hematoma
Brain
Head
Traumatic
Tbi

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