Concusion

Recommendation --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5);score>0?'NEXUS C-Spine Rule recommends obtaining X-ray':'NEXUS C-Spine Rule supports not obtaining X-ray'" memo="Recommendation"]

Canadian CT Head Injury/Trauma Rule
[comment memo="Only apply to:
•Glasgow Coma Scale (GCS) 13-15 with LOC
•Amnesia to the head injury event
•Confusion
Exclusion Criteria:
•Age <16
•Blood thinners
•Seizure after injury"]
High risk criteria:
[select name="Q6" value="NO=0|YES=1"] <-- GCS <15 at 2 hours post-injury
[select name="Q7" value="NO=0|YES=1"] <-- Suspected open or depressed skull fracture
[select name="Q8" value="NO=0|YES=1"] <-- Any sign of basilar skull fracture? (Hemotympanum, raccoon eyes, Battle’s Sign, CSF oto-/rhinorrhea)
[select name="Q9" value="NO=0|YES=1"] <-- ≥ 2 episodes of vomiting
[select name="Q10" value="NO=0|YES=1"] <-- Age ≥ 65
Medium Risk Criteria
[select name="Q11" value="NO=0|YES=1"] <-- Retrograde amnesia to the event ≥ 30 minutes
[select name="Q12" value="NO=0|YES=1"] <-- “Dangerous” mechanism? Pedestrian struck by motor vehicle, occupant ejected from motor vehicle, or fall from > 3 feet or > 5 stairs.
Recommendation --> [calc value="score=(Q6)+(Q7)+(Q8)+(Q9)+(Q10)+(Q11)+(Q12);score>0?'Consider CT Head':'CT unnecessary'" memo="Recommendation"]

Glasgow Coma Scale
[select name="eye" value="Does not open eyes (1 point)=1|Opens eyes to painful stimulus (2 points)=2|Opens eyes to verbal stimulus (3 points)=3|Opens eyes spontaneously (4 points)=4"] <-- Eye Response
[select name="speech" value="Makes no sounds (1 point)=1|Is incomprehensible (2 points)=2|Uses words inappropriately (3 points)=3|Is disoriented or confused (4 points)=4|Is oriented; speech is normal (5 points)=5"] <-- Speech
[select name="movement" value="Does not move (1 point)=1|Exhibits abnormal extension to painful stimulus (decerebrate response) (2 points)=2|Exhibits abnormal flexion to painful stimulus (decorticate response) (3 points)=3|Withdraws from painful stimulus (4 points)=4|Responds locally to painful stimulus (5 points)=5|Obeys verbal commands (6 points)=6"] <-- Movement

[comment memo="Assessment and Plan"]
Patient presenting with head injury which has resulted in a concussion.  Patient's neurological exam was non-focal and unremarkable. At this time there is no indication for CT [select value="as patient had no LOC, amnesia, or disorientation|based on negative Canadian CT Head Injury/Trauma Rule"] . I instructed patient to return to clinic or present to emergency department urgently if new or worsening symptoms develop.  

-Temporary Profile for 14 days issued
-Quarters 24 hours
-Cognitive rest (no TV, video games, texting, computers, etc.) for next 24 hours
-Acetaminophen for pain control
-No physical training, no working out until reevaluation during follow 
-Patient given CDC's handout "What to Expect After a Concussion"
-Patient follow up in clinic for repeat TBI NSI tomorrow

Patient verbally expressed understanding and all questions were addressed to patient's satisfaction.