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    Head Injury

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    Mehrun Nisha
    1. The document discusses the management of acute traumatic head injuries, which cause about 1 million deaths per year in India. 2. It outlines the evaluation, treatment, and management of head injuries in the ICU, including monitoring vital signs, indications for surgery, measures to reduce intracranial pressure like mannitol and decompressive craniectomy, and goals for oxygen saturation, blood pressure, ICP, and CPP. 3. Factors influencing prognosis are discussed, such as younger patients having better potential for recovery, mortality increasing with age over 65, and hypotension, hypoxia, and delays in treatment worsening outcomes.

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    Head Injury

    Uploaded by

    Mehrun Nisha
    17 views41 pages
    1. The document discusses the management of acute traumatic head injuries, which cause about 1 million deaths per year in India. 2. It outlines the evaluation, treatment, and management of head injuries in the ICU, including monitoring vital signs, indications for surgery, measures to reduce intracranial pressure like mannitol and decompressive craniectomy, and goals for oxygen saturation, blood pressure, ICP, and CPP. 3. Factors influencing prognosis are discussed, such as younger patients having better potential for recovery, mortality increasing with age over 65, and hypotension, hypoxia, and delays in treatment worsening outcomes.

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    1. The document discusses the management of acute traumatic head injuries, which cause about 1 million deaths per year in India. 2. It outlines the evaluation, treatment, and management of head injuries in the ICU, including monitoring vital signs, indications for surgery, measures to reduce intracranial pressure like mannitol and decompressive craniectomy, and goals for oxygen saturation, blood pressure, ICP, and CPP. 3. Factors influencing prognosis are discussed, such as younger patients having better potential for recovery, mortality increasing with age over 65, and hypotension, hypoxia, and delays in treatment worsening outcomes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views41 pages

    Head Injury

    Uploaded by

    Mehrun Nisha
    1. The document discusses the management of acute traumatic head injuries, which cause about 1 million deaths per year in India. 2. It outlines the evaluation, treatment, and management of head injuries in the ICU, including monitoring vital signs, indications for surgery, measures to reduce intracranial pressure like mannitol and decompressive craniectomy, and goals for oxygen saturation, blood pressure, ICP, and CPP. 3. Factors influencing prognosis are discussed, such as younger patients having better potential for recovery, mortality increasing with age over 65, and hypotension, hypoxia, and delays in treatment worsening outcomes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 41

    Dr.

    Manoranjitha Kumari MCh

    Management of Acute Traumatic


    Head Injury
    Introduction ..
    Incidence of Head Injury Indian
    Scenario....
    • 1.5 to 2 million persons are injured
    • 1 million succumb to death every year in
    India.

    Neurol Res. 2002 Jan;24(1):24-8.


    Epidemiology of traumatic brain injuries: Indian scenario.
    Gururaj G1
    Causes ..

    Alcohol involvement-10-15%
    Mechanism of injury
    Types of head injury
    DAI
    • Management ...
    Evaluation
    • ATLS—ABC’s
    • History
    – loss of consciousness
    • Physical exam
    – Glasgow Coma Scale
    • Radiographic studies
    – CT Scan
    GCS
    Classifying based on GCS
    Guidelines..
    Radiologic examination
    • CT scan
    – required in ALL cases EXCEPT:
    • LOC is brief
    AND
    • patient can be serially examined
    – lesions
    • focal--epidural, subdural hematoma,
    contusions
    • diffuse--diffuse axonal injury
    • Plain films
    – useful only to detect skull fracture but in the trauma
    setting wastes time
    SDH EDH
    Indication of surgery
    • EDH more than 30 cc clot
    • SDH more than 1 cm thickness
    • ICH more than 30 CC
    • Compound depressed fractures
    • Any deterioration of GCS by 2, from the time
    of admission even with lesser volume of clot
    • Increased intra cranial pressure
    Hyper acute management in the ICU
    • Initial
    – Intubation if unresponsive or combative to give
    controlled ventilation
    – pharmacologic paralysis
    • after neurologic exam is completed
    – Blood pressure and O2 saturation monitoring
    • keep systolic > 90 mm Hg
    • 100% O2 saturation
    ICP monitoring
    • Indications
    – severe head injury (GCS < 9)
    • abnormal head CT
    or
    • Coma >6 hrs
    – Intracranial hematoma requiring evacuation
    – Delayed neurologic deterioration from mild to
    moderate (GCS>9) to severe (GCS < 8)
    – Requirement for prolonged ventilation
    – Pulmonary injury, surgery etc.
    Measures to reduce ICP
    • Hyper osmolar therapy
    mannitol, 3% NACL, Glycerol
    Decompressive craniectomy
    Ventilation with paralysing agent
    ICU management goals
    • O2 saturation 100%
    • Mean arterial pressure 90-110 mm Hg
    • ICP < 20 mm Hg
    • Cerebral Perfusion Pressure (CPP=MAP-ICP)
    >70 mm Hg
    CPP
    Icu adjuncts
    • HCT~ 30-33%
    • PaCO2= 35±2 mm Hg
    • CVP= 8-14 mm Hg
    • avoid dextrose IV
    • maintain euthermia or mild hypothermia
    Other issues
    • DVT prophylaxis
    • Antibiotics
    • Anti epileptics
    • Nutrition
    Factors Influencing Prognosis

    • Age
    – Younger pts have greatest potential for survival and
    recovery
    – 61-75% mortality if over 65
    – 90% mortality in elderly with ICP >20 and coma for more
    than 3 days
    – 100% mortality if GCS < 5, uni- or bilateral dilated pupils,
    and age over 75
    • survival and recovery not
    predictable except in old pts

    • Treat presuming recovery


    Factors Influencing Prognosis

    • Hypotension--50% increase in mortality with


    single episode of hypotension
    • Hypoxia
    • Delay in treatment
    – prolonged transport
    – surgical delay when lateralizing signs present

    Potentially controllable!!

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