head injury according to atls guidelines

1. HEAD INJURY
DR.MUMTAZ ALI NAREJO
CONSULTANT NEUROSURGEON

2. OUTLINES
• Introduction
• Anatomy
• Physiology
• Classification
• Evidence based treatment
• Primary survey
• Secondary survey
• Diagnostic Procedure
• Medical Treatment
• Surgical treatment
• Prognosis
• Brain death

3. INTRODUCTION
• Most common
• 90% of Prehospital deaths
• Mild : 75%
• Moderate : 15%
• Severe : 10%
• USA : TBI/anum :1,700,000
• Hospitalizations : 275000
• Deaths : 52000
• Disability : 80000-90000
• Neuropsychological
• Adequate oxygenation
• Maintaining B.P & Perfusion to brain

4. ANATOMY

5. ANATOMY

6. PHYSIOLOGY
• Normal ICP: 8-15 mm Hg
• Raise ICP =>
reduce cerebral perfusion
cause/exacerbate ischemia
• ICP > 22 mm Hg
refractory to treatment
poor outcomes
• (CPP = MAP – ICP)
• Autoregulation

8. CLASSIFICATION

17. PRIMARY/SECONDARY
• A=Early ETT
Transient respiratory arrest
hypoxia
• B= 100% O2 , 35 mm Hg CO2
• C = Euvolemia
• SBP > 100 mm Hg
50-69 years
• SBP>11O mm Hg
15-49 years >70 years
• Neurological exam
• Secondary survey
• Diagnostic : CT scan

18. MEDICAL Rx
• I/V FLUIDS:
Hypovolemia
N/S & R/L
Hypotonic & glucose
Hyponatremia
• Correction of anticoagulation
• Hyperventilation:
Dec PCO2,Vasoconstriction
Prolonged:dec CPP ,ischemia
PCO2 > 45 mm Hg: inc ICP
PCO2<25 mm Hg

19. • Mannitol :
• Dec ICP
• 20%
• Hypotension
• Bolus 1g/kg for 5 min
• 0.25-1 g/kg
• Hypertonic saline : 3% & 23.4%
• Barbiturates
• Anticonvulsants

20. SURGICAL RX
• Scalp wound
• Depressed skull fracture
• Intracranial mass lesion
• Penetrating brain injury
• Prognosis

21. BRAIN DEATH
• Criteria:
Glasgow Coma Scale score = 3
 Nonreactive pupils
Absent brainstem reflexes (e.g., oculocephalic,corneal, and doll’s eyes, and no gag
reflex)
No spontaneous ventilatory effort on formal apnea testing
 Absence of confounding factors such as alcohol or drug intoxication or hypothermia
• Ancillary studies that may be used to confirm the diagnosis of brain death include:
Electroencephalography: No activity at high gain
CBF studies: No CBF (e.g., isotope studies,Doppler studies, xenon CBF studies)
Cerebral angiography

22. Refrences
• ATLS student course manual 10th edition
• Greenberg Handbook of Neurosurgery 10th edition
• Google

23. THANKS