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    Head Trauma: Dr. Nasir Lamhot, Sp. BS

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    Yohannes Kurniawan
    The document discusses head trauma and brain injuries. It covers physiology concepts like intracranial pressure, cerebral blood flow, and the Monro-Kellie doctrine. Injuries are classified by severity using the GCS scale and by morphology such as skull fractures and intracranial lesions including contusions, hematomas, and diffuse axonal injury. Management approaches are presented for minor, moderate and severe brain injuries, along with indications for CT scanning and guidelines for primary and secondary surveys, intravenous fluids, mannitol, hypertonic saline, and surgical treatments.

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    Head Trauma: Dr. Nasir Lamhot, Sp. BS

    Uploaded by

    Yohannes Kurniawan
    39 views31 pages
    The document discusses head trauma and brain injuries. It covers physiology concepts like intracranial pressure, cerebral blood flow, and the Monro-Kellie doctrine. Injuries are classified by severity using the GCS scale and by morphology such as skull fractures and intracranial lesions including contusions, hematomas, and diffuse axonal injury. Management approaches are presented for minor, moderate and severe brain injuries, along with indications for CT scanning and guidelines for primary and secondary surveys, intravenous fluids, mannitol, hypertonic saline, and surgical treatments.

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    Head Trauma

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    Head Trauma

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    The document discusses head trauma and brain injuries. It covers physiology concepts like intracranial pressure, cerebral blood flow, and the Monro-Kellie doctrine. Injuries are classified by severity using the GCS scale and by morphology such as skull fractures and intracranial lesions including contusions, hematomas, and diffuse axonal injury. Management approaches are presented for minor, moderate and severe brain injuries, along with indications for CT scanning and guidelines for primary and secondary surveys, intravenous fluids, mannitol, hypertonic saline, and surgical treatments.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    39 views31 pages

    Head Trauma: Dr. Nasir Lamhot, Sp. BS

    Uploaded by

    Yohannes Kurniawan
    The document discusses head trauma and brain injuries. It covers physiology concepts like intracranial pressure, cerebral blood flow, and the Monro-Kellie doctrine. Injuries are classified by severity using the GCS scale and by morphology such as skull fractures and intracranial lesions including contusions, hematomas, and diffuse axonal injury. Management approaches are presented for minor, moderate and severe brain injuries, along with indications for CT scanning and guidelines for primary and secondary surveys, intravenous fluids, mannitol, hypertonic saline, and surgical treatments.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 31

    HEAD TRAUMA

    dr. Nasir Lamhot, Sp. BS


    Meningeal Layers
    Physiology: ICP
    Intracranial Pressure increased ICP
    decreased cerebral bloodflow + ischemia
    Normal ICP = 20mmHg
    Physiology: Monro-Kellie Doctrine
    Total intracranial volume has to be constant.
    increased ICP venous blood + CSF pumped
    out compensation mechanism
    Physiology: Cerebral Blood Flow
    Cerebral Perfusion Pressure = Mean Arterial
    Pressure Intracranial Pressure
    TBI decreased MAP, increased ICP
    decreased CPP
    Classification
    Severity
    Minor GCS 13-15
    Moderate GCS 9-12
    Severe GCS 3-8
    Classification
    Morphology
    Skull fracture
    Vault
    Linear vs Stelata
    Depressed / nondepressed
    Open/closed
    Basillar
    With/without CSF leak
    With/without seventh nerve palsy
    Intracranial lession
    Focal (EDH, SDH, ICH)
    Diffuse (Concussion, multiple contusions,
    hypoxic/ischemic injury, axonal injury)
    Skull Fractures
    Basilar skull fracture:
    Racoon eyes (periorbital ecchymosis)
    Battles sign (retroauricular ecchymosis)
    Rhinorrhea (CSF leakage)
    Otorrhea (CSF leakage)
    7th and 8th nerve dysfucntion (facial paralysis and
    hearing loss)
    Intracranial Lessions : Diffuse
    Severe diffuse injuries often result from a
    hypoxic, ischemic insult to the brain due to
    prolonged shock or apnea occuring immediately
    after the trauma.
    High velocity impact / deceleration injury
    punctate hemorrhage often seen in the border
    between grey matter and hite matter DAI
    (Diffuse Axonal Injury)
    Intracranial Lessions : Focal
    EDH (epidural hematoma)

    SDH (subdural hematoma)

    ICH (intracranial hematoma)


    EDH
    Uncommon occuring
    only 0,5%
    Hematoma biconvex /
    lenticular
    @ temporal /
    temporoparietal region
    middle meningeal artery
    Lucid interval classic
    presenteation of EDH
    SDH
    Common >> EDH
    occuring 30% in brain
    injuries
    Bleeding source
    bridging vein
    Shape conform the
    contours of the brain
    More severe >> EDH
    parenchymal injury
    Contusions and ICH
    Cerebral contusion fairly common 20-30%
    in brain injuries
    @frontal, temporal lobes
    Hours, days evolve intracerebral
    hematoma mass effect requiring surgical
    evacuation
    Management: Minor Brain Injury
    Management: Moderate Brain Injury
    Management: Severe Brain Injury
    Indication for CT Scanning MTBI
    High risk:
    GCs <15 2 hours after injury
    Suspect : open / depressed fracture
    Sign of basillar skull fracture
    Vomiting (>2 episodes)
    Age >65 years old
    Indication for CT Scanning MTBI
    Moderate risk:
    Loss of consciusness > 5 minutes
    Amnesia before impact > 30 minutes
    Dangerous mechanism
    Primary Survey
    Step 1 : ABCDE
    Step 2: Immobilize and stabilize the cervical
    spine
    Step 3: Brief neurologic examination
    pupillary response, GCS, lateralizing signs
    Secondary Survey
    Step 1: Inspect : head, face
    laceration, CSF leakage from nose/ear
    Step 2: Palpate : head, face
    fracture, laceration overlying fracture
    Step 3: Inspect : all scalp laceration
    brain tissue, depressed skull fracture, debris CSF
    leaks
    Step 4: determine GCS + pupillary response
    eye-opening response, best limb motor response
    Medical Therapies: IVFD
    Intravenous fluid prevent hypovolemia
    HARMFUL
    Recommendation ringer lactate / normal
    saline
    Medical Therapies: Mannitol
    Reduce elevated CP
    Important!! Do not give mannitol to hypotensive
    patient! osmotic diuretic more hypotensive
    Indication : acute neurologic deterioration
    dilated pupils, hemiparesis, loss of
    consciousness
    1g/kg; bolus in 5 minutes
    Medical Therapies : Hypertonic Saline
    Preferable in hypotensive patient do not act
    as diuretic
    Surgical Treatment
    Scalp wound
    Depressed skull fracture
    Intracranial mass lesions
    Penetrating brain injuries
    Source
    ATLS 9th edition

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