This presentation describe a quick overview about head injury and then talks about a patient with Head injury and the management from respiratory point of view.

1. Head Injury
Mahdi alshehri

2. Objectives :
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Definition .
Classification .
Signs and symptoms .
Diagnosis .
Management .
MV case scenario (head injury) .

3. Definition :
• Head injury refers to trauma of the head.
• This may or may not include injury to the
brain

4. Classification :
Head injuries may be closed or open :
A closed (non-missile) head injury is where the
dura mater remains intact .

5. Cont :
• Traumatic brain injury (TBI) :
This term refers to a mild brain injury. This injury is
a result due to a blow to the head that could
make the person’s physical, cognitive, and
emotional behaviors irregular.
Symptoms may include: Fatigue, Confusion ,Nausea
Headaches.

6. Cont :
• Intracranial hemorrhage
Types of intracranial hemorrhage are roughly
grouped into intra-axial and extra-axial. The
hemorrhage is considered a focal brain injury;
that is, it occurs in a localized spot rather than
causing diffuse damage over a wider area.

7. • Cerebral contusion :
Cerebral contusion is bruising of the brain tissue.
The majority of contusions occur in the frontal
and temporal lobes.
The goal of treatment should be to treat the
increased intracranial pressure.

8. Signs and symptoms
• Presentation varies according to the injury.
Some patients with head trauma stabilize and
other patients deteriorate. A patient may
present with or without neurologic deficit.
• Common symptoms of head injury include
coma, confusion, drowsiness, personality
change, seizures, nausea and
vomiting, headache.

9. Causes
Common causes of head injury are motor vehicle
traffic , home and occupational accidents, falls.

10. Diagnosis
The need for imaging in patients who have
suffered a minor head injury is debated. A
non-contrast CT of the head should be
performed immediately in all those who have
suffered a moderate or severe head injury
, MRI is also an option.

11. Management
• Most head injuries are of a benign nature and
require no treatment beyond analgesics and
close monitoring for potential complications
such as intracranial bleeding.
• neurosurgical evaluation may be useful.
• Treatments may involve controlling elevated
intracranial pressure.

12. MV case scenario (head injury)

13. History :
• A 24 years old Saudi male IBW 75 kg admitted to
Abqiq general hospital at 26 – 5 – 1433. RTA with
a sever head injury and polytrauma. GCS 7/15
, BP: 166/70 , pupils bilateral reactive .
Immediately intubated by ETT 7.5 mm at level 22
cm.
• Medication :
fentanyl 100 ug
midazolam 4 mg
• Patient on SIMV / PS
Vt : 400 ml
RR: 12 b/min
PS: 10 cmH2O
FIO2 :40 %

14. • Chest X-Ray : Left ribs # 6th . 7th . 8th .
• Spinal X-Ray : # C4 ,C5

16. • second day patient refer to out ICU on
portable ventilation Fio2 75% to Dammam
medical complex.
• CT : bilateral brain contusion
bilateral lung contusion
• The patient admitted under neurosurgery as
care of head trauma .

17. ABG Result :
Ventilator sitting :
PH: 7.45
PaCO2: 36 mmgh
PaO2: 292 mmgh
HCO3:26
FiO2:75%
Mode: SIMV + PS
VT : 450 ml
RR: 12 b/m
Spontaneous R : 0
FEEP :5 cmH2O
PS:12 cmH2O
Flow Trigger : 3
I:E 1:3.2
PIP : 17 cmH2O
Decrease FiO2 to 40%

18. 29-5 -33
ABG Result :
PH: 7.36
PaCO2: 60 mmgh
PaO2: 67 mmgh
HCO3:30
FiO2:40%
Ventilator sitting :
Mode: SIMV + PS
VT : 450 ml
RR: 18 b/m
Spontaneous R : 0
FEEP :5 cmH2O
PS:12 cmH2O
Flow Trigger : 3
I:E 1:3.2
PIP : 17 cmH2O
FiO2 : 60%

19. 1-6-33
ABG Result :
PH: 7.46
PaCO2: 44 mmgh
PaO2: 117 mmgh
HCO3:31
FiO2:50%
Ventilator sitting :
Mode: SIMV + PS
VT : 450 ml
RR: 16 b/m
Spontaneous R : 0
FEEP :5 cmH2O
PS:12 cmH2O
Flow Trigger : 3
I:E 1:2.8
PIP : 18 cmH2O
FiO2 : 45%

20. 2-6-33
ABG Result :
PH: 7.44
PaCO2: 43 mmgh
PaO2: 134 mmgh
HCO3:29
FiO2:45%
Ventilator sitting :
Mode: SIMV + PS
VT : 450 ml
RR: 16 b/m
Spontaneous R : 0
FEEP :5 cmH2O
PS:12 cmH2O
Flow Trigger : 3
I:E 1:2.8
PIP : 17 cmH2O
FiO2 : 40%

21. 3-6-33
ABG Result :
PH: 7.47
PaCO2: 39 mmgh
PaO2: 82 mmgh
HCO3:28
FiO2:30%
Ventilator sitting :
Mode: SIMV + PS
VT : 450 ml
RR: 16 b/m
Spontaneous R : 0
FEEP :5 cmH2O
PS:12 cmH2O
Flow Trigger : 3
I:E 1:2.8
PIP : 14 cmH2O
FiO2 : 30%

22. 8-6-33
The sedative stop for neurological assessment
and trial for weaning .
• Open eyes spontaneous .
• Flex to pain
• Slightly movement of right upper limp .
right lower limp.

23. Cont
ABG Result :
PH: 7.46
PaCO2: 38 mmgh
PaO2: 102 mmgh
HCO3:28
FiO2:30%
Ventilator sitting :
Mode: SIMV + PS
VT : 450 ml
RR: 14 b/m
Spontaneous R : 5
FEEP :5 cmH2O
PS:12 cmH2O
Flow Trigger : 3
I:E 1:3.3
PIP : 14 cmH2O
FiO2 : 30%

24. When sedative hold for weaning the patient
become :
• Tachypnea
• Tachycardia
• Feverish
For that the weaning trial stop .
• After several day patient transfer to OR for a
brain surgery .