# History

History

Mechanism In moderate and severe TBI, a history must be obtained from witnesses and paramedics. High-energy mechanisms of injury , including a fall from a height or a high-speed road accident, will require careful clinical and radiological exclusion of  associated multisystem and spinal injury (see Chapters 27 and 30 ). In the case of  road tra ffi c accidents in particular, extraction time and evidence of  hypoxia or haemodynamic instability at the scene is important information to obtain from the paramedics. Falls such as myocardial infarction, hypoglycaemia or subarachnoid haemorrhage, with crucial implications for management. Neurological progression A specific check should be made for any loss of  consciousness at the time of  injury and its duration. The GCS score and pupil responses should be recorded at the scene, during transfer, at admission and regularly thereafter. A deterioration in the GCS score is an important index of  developing a potentially reversible secondary injury . It is also useful to assess the extent of  amnesia, retrograde (events prior to the injury) and antero grade (events afterwards). If  the patient was intubated at the scene of  the accident, it is valuable to know whether the patient was moving all four limbs before this. Past medical history Obtain details of the patient’s medical background, including allergies and normal medications. Of  particular note here are antiplatelet agents, potentially requiring platelet transfusion especially if  surgery is required, and anticoagulants, which may need reversal. Summary box 28.3 History /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF 

Bystanders and paramedics may give vital information on the:
Preinjury state (
/f_i
ts, alcohol, chest pain)
Mechanism and energy involved in the injury (speed of
vehicles, height fallen)
Conscious state and haemodynamic stability of the patient
after the accident
Length of time taken for extrication
Check the medication history, especially anticoagulants and
antiplatelet agents

History

Mechanism In moderate and severe TBI, a history must be obtained from witnesses and paramedics. High-energy mechanisms of injury , including a fall from a height or a high-speed road accident, will require careful clinical and radiological exclusion of  associated multisystem and spinal injury (see Chapters 27 and 30 ). In the case of  road tra ffi c accidents in particular, extraction time and evidence of  hypoxia or haemodynamic instability at the scene is important information to obtain from the paramedics. Falls such as myocardial infarction, hypoglycaemia or subarachnoid haemorrhage, with crucial implications for management. Neurological progression A specific check should be made for any loss of  consciousness at the time of  injury and its duration. The GCS score and pupil responses should be recorded at the scene, during transfer, at admission and regularly thereafter. A deterioration in the GCS score is an important index of  developing a potentially reversible secondary injury . It is also useful to assess the extent of  amnesia, retrograde (events prior to the injury) and antero grade (events afterwards). If  the patient was intubated at the scene of  the accident, it is valuable to know whether the patient was moving all four limbs before this. Past medical history Obtain details of the patient’s medical background, including allergies and normal medications. Of  particular note here are antiplatelet agents, potentially requiring platelet transfusion especially if  surgery is required, and anticoagulants, which may need reversal. Summary box 28.3 History /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF 

Bystanders and paramedics may give vital information on the:
Preinjury state (
/f_i
ts, alcohol, chest pain)
Mechanism and energy involved in the injury (speed of
vehicles, height fallen)
Conscious state and haemodynamic stability of the patient
after the accident
Length of time taken for extrication
Check the medication history, especially anticoagulants and
antiplatelet agents

History

Mechanism In moderate and severe TBI, a history must be obtained from witnesses and paramedics. High-energy mechanisms of injury , including a fall from a height or a high-speed road accident, will require careful clinical and radiological exclusion of  associated multisystem and spinal injury (see Chapters 27 and 30 ). In the case of  road tra ffi c accidents in particular, extraction time and evidence of  hypoxia or haemodynamic instability at the scene is important information to obtain from the paramedics. Falls such as myocardial infarction, hypoglycaemia or subarachnoid haemorrhage, with crucial implications for management. Neurological progression A specific check should be made for any loss of  consciousness at the time of  injury and its duration. The GCS score and pupil responses should be recorded at the scene, during transfer, at admission and regularly thereafter. A deterioration in the GCS score is an important index of  developing a potentially reversible secondary injury . It is also useful to assess the extent of  amnesia, retrograde (events prior to the injury) and antero grade (events afterwards). If  the patient was intubated at the scene of  the accident, it is valuable to know whether the patient was moving all four limbs before this. Past medical history Obtain details of the patient’s medical background, including allergies and normal medications. Of  particular note here are antiplatelet agents, potentially requiring platelet transfusion especially if  surgery is required, and anticoagulants, which may need reversal. Summary box 28.3 History /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF 

Bystanders and paramedics may give vital information on the:
Preinjury state (
/f_i
ts, alcohol, chest pain)
Mechanism and energy involved in the injury (speed of
vehicles, height fallen)
Conscious state and haemodynamic stability of the patient
after the accident
Length of time taken for extrication
Check the medication history, especially anticoagulants and
antiplatelet agents