Case Study - MVA GCS

An 18-year-old woman was a restrained driver of a vehicle that was T-boned (lateral) at a high speed on the driver's side of the car. The car subsequently rolled over onto its roof. Emergency medical services arrived to find the victim conscious but with a Glasgow Coma Scale (GCS) Score of 13 (Table 1). The victim's pupils were noted to be equal and reactive. The victim's level of consciousness continued to deteriorate while the emergency medical services worked to free her from the wreckage. She arrived at the regional emergency department after 40-minute extrication with a GCS Score of 8: she was given a 2 for opens eyes to painful stimuli, a 2 for unintelligible verbal response, and a 4 for withdraws to pain. Her pupils were now unequal. The right pupil measured 5 mm and was nonreactive to a direct light, whereas her left pupil measured 2 mm and displayed a sluggish reaction to direct light. She was noted to have a small forehead laceration with surrounding ecchymosis. She was sedated, paralyzed, and intubated by the emergency department staff to ensure airway protection. A computerized tomography (CT) scan of the patient's head was performed, which revealed a large subdural hematoma. The patient's neurologic status continued to deteriorate, and, therefore, the local air medical service was immediately dispatched to transport the patient to a level I trauma center. She was transported to a level I trauma center for further evaluation of her head injury. Upon her arrival to the trauma center, her trauma evaluation was completed, and she was transferred to the surgical intensive care unit. Her pupils were found nonreactive on her initial trauma evaluation at the trauma center. In the surgical intensive care unit, a neurosurgical consultation for the treatment of an acute subdural hematoma and possible surgical evacuation was obtained.