Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Atls head trauma modified pdf
Similar to Atls head trauma modified pdf (20)
More from Yousuf Mahomed
More from Yousuf Mahomed (18)
Recently uploaded
Recently uploaded (20)
Atls head trauma modified pdf
- 1. Committee on Trauma Presents ©ACS Head Trauma
- 2. Objectives ➢ Describe basic intracranial physiology. ➢ Recognize the importance of limiting secondary brain injury. ➢ Perform a focused neurologic exam. ➢ Stabilize and arrange for definitive care. ©ACS
- 3. ➢ Rigid, nonexpansile skull filled with brain, CSF, and blood ➢ CBF autoregulation ➢ Autoregulatory compensation disrupted by brain injury ➢ Mass effect of intracranial hemorrhage ©ACS Anatomy and physiology effects?
- 4. Monro-Kellie Doctrine ©ACS Ven. Vol. Art. Vol. Brain CSFMass Arterial Volume Brain CSF 75 mL Mass 75 mL Venous Volume Art. Vol. Brain CSF
- 5. Volume – Pressure Curve ©ACS Volume of Mass 60- 55- 50- 45- 40- 35- 30- 25- 20- 15- 10- 5- ICP (mm Hg) Compensation Herniation Point of Decompensation
- 6. Intracranial Pressure (ICP) ➢ 10 mm Hg = Normal ➢ > 20 mm Hg = Abnormal ➢ > 40 mm Hg = Severe ➢ Many pathologic processes affect outcome ➢ Sustained ↑ ICP leads to ↓ brain function and outcome ©ACS
- 7. Cerebral Perfusion Pressure* ©ACS * CPP ≠ Cerebral Blood Flow MBP ICP CPP Normal Cushing’s Response Hypotension – = 30 90 100 50 10 80 20 20 80
- 8. Autoregulation ➢ If autoregulation is intact, CBF is maintained with a mean BP of 50 to 160 mm Hg. ➢ Moderate or severe brain injury: Autoregulation often impaired ➢ Brain more vulnerable to episodes of hypotension → secondary brain injury ©ACS
- 9. Mild Brain Injury ©ACS ➢ GCS Score = 14–15 ➢ History ➢ Exclude systemic injuries ➢ Neurologic exam ➢ X-rays as indicated ➢ Alcohol / drug screens as indicated ➢ Liberal use of head CT Observe or discharge based on findings
- 10. Moderate Brain Injury ©ACS ➢ GCS Score = 9–13 ➢ Initial evaluation same as for mild injury ➢ CT scan for all ➢ Admit and observe • Frequent neurologic exams • Repeat CT scan ➢ Deterioration: Manage as severe head injury
- 11. Severe Brain Injury ➢ GCS Score = 3–8 ➢ Evaluate and resuscitate ➢ Intubate for airway protection ➢ Focused neurologic exam ➢ Frequent reevaluation ➢ Identify associated injuries ©ACS
- 12. Classifications of Brain Injury ©ACS By Morphology: Brain Focal Diffuse • Epidural (extradural) • Subdural • Intracerebral • Concussion • Multiple contusions • Hypoxic / ischemic injury
- 13. Diffuse Brain Injury ➢ Mild concussion → Severe, ischemic insult ©ACS Normal CT Diffuse Injury
- 14. Contusion / Hematoma ➢ Coup / contracoup injuries ➢ Most common: Frontal / temporal lobes ➢ CT changes usually progressive ➢ Most conscious patients: No operation ©ACS
- 15. Contusion / Hematoma ©ACS Large frontal contusion with shift
- 16. Epidural Hematoma ➢ Associated with skull fracture ➢ Classic: Middle meningeal artery tear ➢ Lenticular / biconvex ➢ Lucid interval ➢ Can be rapidly fatal ➢ Early evacuation essential ©ACS
- 18. Subdural Hematoma ➢ Venous tear / brain laceration ➢ Covers cerebral surface ➢ Morbidity / mortality due to underlying brain injury ➢ Rapid surgical evacuation recommended, especially if > 5 mm shift of midline ©ACS
- 20. Priorities ➢ ABCDE ©ACS ➢ Minimize secondary brain injury • Administer O2 • Maintain blood pressure (systolic > 90 mm Hg)
- 21. Focused Neurologic Exam? ➢ GCS Score ©ACS Consult neurosurgeon early ➢ Pupils ➢ Lateralizing signs
- 22. Indications for CT Scan? ©ACS All patients with suspicion of brain injury
- 23. Medical Management ➢ Controlled ventilation ©ACS ➢ Intravenous fluids • Euvolemia • Isotonic • Goal: Paco2 at 35 mm Hg
- 24. Medical Management ©ACS ➢ Mannitol • Use with signs of tentorial herniation • Dose: 1.0 g / kg IV bolus • Consult with neurosurgeon first
- 25. Medical Management ➢ Other medications ©ACS • Anticonvulsants • Sedation • Paralytics
- 26. Surgical Management ©ACS Scalp Injuries ➢ Possible site of major blood loss ➢ Direct pressure to control bleeding ➢ Occasional temporary closure
- 27. Surgical Management ©ACS Intracranial Mass Lesion ➢ May be life-threatening if expanding rapidly ➢ Immediate neurosurgical consult ➢ Hyperventilation / Mannitol ➢ Damage control craniotomy: Transfer to neurosurgeon (rural / austere areas)
- 28. ©ACS ?
- 29. Summary: What should I do? ➢ Maintain mean BP > 90 mm Hg ➢ Maintain Paco2 near / at 35 mm Hg ➢ Use isotonic solution for euvolemia ➢ Frequent neurologic exams ➢ Liberal use of CT scans ➢ Early neurosurgical consult ©ACS
- 30. Summary: What should I not do? ➢ Allow patient to become hypotensive ➢ Over-aggressively hyperventilate ➢ Use hypotonic IV fluids ➢ Use long-acting paralytics ➢ Paralyze before performing complete exam ➢ Depend on clinical exam alone ©ACS