Aidey
Community Leader Emeritus
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From the research I've done it sounds like it is possible to have posturing from an acute hypoxic event or anoxic brain injury. But I am still a little fuzzy on how similar the presentation to a closed head injury would be, and if it would be possible to tell them apart. And if the symptoms would resolve once the hypoxia was corrected.
Here is the situation. The patient was assaulted, and at the time we had no idea what had happened. That was all the info we had. My judgment at the time was that he had a severe closed head injury. We found out later that he did not have a closed head injury, but he had been strangled into unconsciousness.
This was his presentation, the pt is on a back board, with a c collar on, and someone holding manual c-spine since he wasn't fully strapped down.
Neuro: GCS of 6? (we think, see below)
The patient's initial BP is 150/80 with a pulse of 80. Second BP is 170/100 with a pulse of 54. SpO2 is reading 68% on a mask, however the pt didn't have generalized cyanosis. He had so much blood on his face it was impossible to tell the color of his lips, but I don't believe his SpO2 was that low.
There was no change in his presentation when we talked to him, and he was not following commands. Lower extremities have decorticate posturing and he isn't moving them. He is flailing his arms around but isn't making a fist or trying to grab anything, so as far as we can tell, no purposeful movement. He is grunting occasionally. His eyes are totally swollen shut, with dark bruising around both. The edema so so bad it is difficult to make out the margins of the orbit. There blood leaking out of both eyes. It was impossible to assess eye response for the GCS, so I went with the worst case and gave him a 1.
Anyway, we find out later he had been strangled, and he had no closed head injury or bleeding at all. The eye swelling was from direct trauma to the eyes. As far as I can find out, he was AOx4 the next day, without any obvious deficits.
Here is the situation. The patient was assaulted, and at the time we had no idea what had happened. That was all the info we had. My judgment at the time was that he had a severe closed head injury. We found out later that he did not have a closed head injury, but he had been strangled into unconsciousness.
This was his presentation, the pt is on a back board, with a c collar on, and someone holding manual c-spine since he wasn't fully strapped down.
Neuro: GCS of 6? (we think, see below)
The patient's initial BP is 150/80 with a pulse of 80. Second BP is 170/100 with a pulse of 54. SpO2 is reading 68% on a mask, however the pt didn't have generalized cyanosis. He had so much blood on his face it was impossible to tell the color of his lips, but I don't believe his SpO2 was that low.
There was no change in his presentation when we talked to him, and he was not following commands. Lower extremities have decorticate posturing and he isn't moving them. He is flailing his arms around but isn't making a fist or trying to grab anything, so as far as we can tell, no purposeful movement. He is grunting occasionally. His eyes are totally swollen shut, with dark bruising around both. The edema so so bad it is difficult to make out the margins of the orbit. There blood leaking out of both eyes. It was impossible to assess eye response for the GCS, so I went with the worst case and gave him a 1.
Anyway, we find out later he had been strangled, and he had no closed head injury or bleeding at all. The eye swelling was from direct trauma to the eyes. As far as I can find out, he was AOx4 the next day, without any obvious deficits.
