Table A Clinical Assessment 1 a Medical evaluation

Table A: Clinical Assessment 1. a. Medical evaluation to assess stability with particular attention to cardiopulmonary stability (if patient tachycardic, treat before starting neuropharmacologic treatment for TBI, order an EKG, start on telemetry), b. assessment for ongoing infection (CBC-D, CMP, LFTs, ESR, CRP, if possible bacteremia send procalcitonin level, Cx. R, pan-culture). c. careful review of patient medical history. 2. Neurology evaluation to assess neurologic stability with particular attention to a. craniotomy or hemicraniectomy healing, b. management of seizure medications, c. potential for complications (e. g. hydrocephalus), d. Compare current neurologic exam, with initial assessment, and use brain neuro imaging results to compare neurological gains if necessary per neurologist recommendation. 3. Baseline documentation from neurological evaluation describing impaired level of consciousness, using Coma Recover Scale revised (CRS-R), note reference and multidisciplinary team evaluations to classify the patient based on the scale criteria (see CRS-R scale). 4. Monitoring of sleep wake cycles via sleep log when unclear if the patient is sleeping at night. 5. Wean off of sedating medications (e. g. narcotics as clinically possible). 6. Begin pharmacologic treatment after patient deemed medically stable and after all evaluations completed. 7. After baseline assessment completed: Target areas to monitor for level of responsiveness (e. g. eyes opening, alertness, visual tracking/see subscales of CRS-R). 8. Initial continuous single agent trial with goal to reach response under maximal dosage tolerance, then if necessary consider combination therapy trial and consult neurologist, team and involve Physiatrist before starting combination therapy combo therapy). Peter Iremar Santana et al. Development and Implementation of a Pharmacological Toolkit to Help Providers Manage Level of Consciousness Following Traumatic Brain Injury: A Quality Improvement Project. American Journal of Medicine Studies, 2017, Vol. 5, No. 1, 1 -17. doi: 10. 12691/ajms-5 -1 -1 © The Author(s) 2015. Published by Science and Education Publishing.