Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

TBI · Traumatic Brain Injury

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In one line

·The brain gets hurt at the moment of impact, then can get hurt again from swelling and pressure afterward.

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Normal physiology

·The brain floats inside a hard skull, cushioned by cerebrospinal fluid and fed by a network of tiny blood vessels that bring oxygen and glucose to billions of brain cells.

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What goes wrong

·A blow to the head tears blood vessels and shears nerve fibers, causing bruising, bleeding, and swelling that raise pressure inside the skull and damage brain cells.

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Hallmark signs

·Headache that won't go away or gets worse
·Confusion or trouble remembering things
·Dizziness or trouble keeping balance
·Nausea or vomiting
·Feeling sleepy or hard to wake up
·One pupil bigger than the other, or pupils that don't shrink in bright light
·Weakness or numbness on one side of the body
·Clear or bloody fluid dripping from the nose or ears

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Red flags · escalate now

·Glasgow Coma Scale score below 9 (deep unconsciousness — the brain is badly hurt and the person can't protect their airway)
·One pupil much bigger than the other or pupils that stay wide and don't react to light (sign of a brain bleed pressing on the nerve)
·Repeated vomiting or vomiting that starts hours after the injury (rising pressure inside the skull)
·Seizure after the head injury (the brain's wiring is misfiring from the damage)
·Clear or pink fluid leaking from nose or ears (skull fracture letting brain fluid escape)

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Workup

·Non-contrast head CT scan
·Arterial blood gas (ABG)
·Coagulation panel (PT, PTT, INR, platelet count)
·Serum sodium and osmolality
·Cervical spine CT scan
·Blood alcohol level and urine drug screen

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Treatment

·Secure the airway and intubate if Glasgow Coma Scale ≤ 8
·Elevate the head of the bed 30 degrees and keep the neck straight in midline
·Maintain mean arterial pressure (MAP) 65–70 mmHg and oxygen saturation above 90%
·Emergency surgery (craniotomy) to remove large blood clots or decompress the skull if midline shift > 5 mm or deteriorating exam
·Give mannitol 0.25–1 g/kg IV or 3% hypertonic saline bolus for intracranial pressure (ICP) spikes above 22 mmHg
·Start levetiracetam or phenytoin for seizure prevention in moderate to severe TBI (first 7 days)
·Place external ventricular drain (EVD) or ICP monitor if severe TBI, and keep cerebral blood flow (perfusion) pressure (CPP) 60–70 mmHg

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NCLEX trap

·A headache after head trauma is a red flag — it can mean pressure is building inside the skull. This is an emergency. You must check the ABCs (airway, breathing, circulation), get a CT scan of the head right away, and prepare to lower brain pressure if needed. Never just treat the pain and watch; the window to save the brain is small.
·Brain injury comes in all sizes. Even a mild concussion counts as a traumatic brain injury and can cause problems weeks later. Also, bleeding or swelling inside the skull can grow slowly over hours — someone who looks fine now can crash later. Any head trauma with any symptom (headache, confusion, vomit, dizziness) needs a check-up and often imaging. Never assume mild just because the person looks okay at first.
·High blood pressure in TBI is the body's reflex to fight low oxygen in the brain — but it also makes swelling worse. You want a mean arterial pressure (MAP) of 60–70 mmHg, not higher. You also want normal oxygen, normal CO₂, and normal body temperature. Use hyperosmolar therapy (mannitol or 3% saline) to pull water out of the brain and lower pressure, not just more IV fluids.
·A blown pupil and posturing are LATE signs — the brain is already herniating (being squeezed down through the skull). By then it is often too late to save the person. You must act on the Glasgow Coma Scale (GCS) score, what the CT scan shows, and whether the person is getting worse — BEFORE these late signs appear.
·Brief fast breathing (hyperventilation) can lower brain pressure in an emergency by dropping CO₂ — but only for a short time and only if the brain is about to herniate. Normal ventilation (keeping CO₂ around 35–40 mmHg) is the goal. Use sedation and sometimes paralysis to control breathing if needed, but do not hyperventilate routinely — it starves the brain of blood.
·Stop blood thinners immediately in TBI. The danger of bleeding inside the head is much bigger than the danger of a clot. If the patient was on warfarin, give vitamin K and fresh frozen plasma or prothrombin complex concentrate (PCC) to reverse it. If on a DOAC (like apixaban or rivaroxaban), give the reversal agent if available. Restart only after imaging rules out bleeding and the neurosurgeon says it is safe.

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