After taking an appropriate history, which sign of worsening traumatic brain injury should you watch for?

In the context of traumatic brain injuries (TBI), watching for clear fluid leaking from the nose is a critical sign that indicates a worsening condition. This fluid might be cerebrospinal fluid (CSF), which could suggest a breach in the protective barriers surrounding the brain, often due to a skull fracture or other serious injury. The presence of clear fluid can indicate that the injury could potentially be life-threatening and requires immediate medical attention.

Increased heart rate, while it can be associated with various medical conditions, is not a specific indicator of worsening TBI and can result from factors unrelated to brain injury, such as pain or anxiety. A severe headache can also be somewhat common after a head injury, depending on severity, but it doesn’t necessarily indicate that the condition is worsening. Dilated pupils can indicate possible pressure on the brain or a change in neurological status, but without other accompanying symptoms, such as clear fluid leakage, it may not be as definitive in signaling a progression of injury as the presence of CSF would be. Thus, monitoring for clear fluid from the nose is vital for identifying critical changes in a patient with a TBI.