Which of the following findings constitutes a grave preterminal sign in the head-injured child?
a. bradycardia followed by tachycardia
b. increasingly frequent episodes of hypertension
c. nausea and vomiting
d. severe migraine-type headache
A
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A Correct. A grave preterminal sign in the head-injured child is bradycardia followed by tachycardia. Heart rate is an index of brain stem functions. Bradycardia is frequently associated with ICP. However, tachycardia (sign of blood or fluid loss, hypovolemic shock, hypoxia, anxiety or pain) following bradycardia is a grave preterminal sign.
B Incorrect. Increasingly frequent episodes of hypertension are not a grave preterminal sign in the head-injured child. Hypertension alone may indicate pain, anxiety, or a preexisting condition.
C Incorrect. The child with a moderate head injury may complain of nausea and vomit, but these symptoms are not a grave preterminal sign.
D Incorrect. A severe migraine-type headache is not a grave preterminal sign but may indicate a moderate head injury.
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