Approach to traumatic brain injury Quiz: Ace Your Exams

A 52-year-old man is brought to the emergency department (ED) after being struck by a car while cycling. He was unhelmeted and was thrown at least ten feet. Emergency responders report that he was unconscious when they arrived at the scene, and he has not regained consciousness. The patient arrives with a cervical collar and backboard in place and one large-bore IV in his left arm. On arrival, the patient’s temperature is 36.2 °C (97.2 ºF), pulse is 72/min, respiratory rate is 10, blood pressure is 150/90 mmHg, and SpO2 is 100% on a non-rebreather. On primary survey, the patient’s airway is unobstructed, equal breath sounds are auscultated bilaterally, distal pulses are palpable and symmetric, and a second large-bore IV is placed in the right arm. Pupils are 3mm and reactive bilaterally. The patient does not open his eyes to voice or sternal rub, moans incomprehensibly in response to sternal rub, and withdraws each extremity in response to nail bed pressure. What is the patient’s Glascow Coma Score (GCS), and what is the best next step in management?