This document provides information on head injuries, including definitions, classifications, mechanisms of injury, imaging findings, and management strategies. It discusses the types of head injuries such as concussions, extradural and subdural hematomas, and intracerebral hemorrhages. Risk factors for secondary brain injury and guidelines for CT imaging are also outlined. Management of increased intracranial pressure and severe head injuries is described.
Head injury can range from minor scalp lacerations to serious brain injury. It is a leading cause of death from trauma. The most common causes are motor vehicle accidents, falls, assaults, and sports-related injuries. Injuries can be blunt or penetrating. Types of brain injuries include concussions, diffuse axonal injury, contusions, lacerations, and hemorrhages such as epidural, subdural, subarachnoid, intracerebral, and intraventricular hemorrhages. Clinical presentation depends on the type and severity of injury.
1. Acute cholecystitis is an inflammation of the gallbladder, often caused by gallstones leading to obstruction and infection. It can be classified based on morphology from catarrhal to gangrenous.
2. Clinical symptoms include right upper quadrant pain, fever, nausea, and vomiting. Investigations reveal elevated white blood cell count and liver enzymes. Ultrasound and MRI are used for diagnosis.
3. Treatment involves antibiotics, IV fluids, and usually open or laparoscopic cholecystectomy. Subtotal cholecystectomy may be needed in severe cases or those with cirrhosis due to thicker gallbladder walls and collateral vessels. Care must be taken to identify anatomy and avoid bile duct
This document provides an overview of head injuries, including definitions, surgical anatomy of relevant structures like the scalp, skull, meninges and brain, epidemiology, etiology, classifications, pathophysiology, clinical presentation, workup and management. It discusses different types of head injuries such as blunt and penetrating injuries, and classifications based on integrity of the dura mater, site of injury and pathology. Specific types of injuries like fractures, hematomas, and brain injuries are described in detail.
4 million people experience head trauma annually, with severe head injury being a leading cause of trauma death. Timely treatment is critical to prevent increased intracranial pressure from hemorrhages or edema, which can cause permanent brain damage or death. Signs of increased ICP include changes in vital signs, pupil reactivity, eye movements, muscle tone, and level of consciousness on the Glasgow Coma Scale. Early interventions like oxygen supplementation, ventilation support, and maintaining normal blood pressure and carbon dioxide levels are important to preserve brain perfusion and prevent further neurological injury.
Head injuries can range from minor cuts to serious conditions like concussions, contusions, hemorrhages or compression of the brain. Concussions involve temporary impairment of brain functions like thinking or vision from a blow to the head. Contusions cause bruising of the brain tissue which can lead to prolonged unconsciousness. Hemorrhages refer to bleeding within the skull from damaged blood vessels. Signs of a serious head injury include deep cuts, nausea, visual issues or unconsciousness. First aid involves protecting the airway, controlling bleeding from cuts and seeking immediate medical help.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
This document discusses head injuries, including their epidemiology, pathophysiology, types, and management. Head injuries are a major public health problem worldwide and are mostly caused by road traffic accidents and assaults. The main types of head injuries discussed are cerebral contusions, diffuse axonal injury, cerebral edema, traumatic intracranial hematomas such as extradural, subdural, subarachnoid and intracerebral hemorrhages, and concussions. Initial management focuses on preventing secondary brain damage through measures such as neurological observation, immobilization, intubation if needed, and transport to a dedicated neurological facility for patients with more severe injuries.
Head injury can range from minor scalp lacerations to serious brain injury. It is a leading cause of death from trauma. The most common causes are motor vehicle accidents, falls, assaults, and sports-related injuries. Injuries can be blunt or penetrating. Types of brain injuries include concussions, diffuse axonal injury, contusions, lacerations, and hemorrhages such as epidural, subdural, subarachnoid, intracerebral, and intraventricular hemorrhages. Clinical presentation depends on the type and severity of injury.
1. Acute cholecystitis is an inflammation of the gallbladder, often caused by gallstones leading to obstruction and infection. It can be classified based on morphology from catarrhal to gangrenous.
2. Clinical symptoms include right upper quadrant pain, fever, nausea, and vomiting. Investigations reveal elevated white blood cell count and liver enzymes. Ultrasound and MRI are used for diagnosis.
3. Treatment involves antibiotics, IV fluids, and usually open or laparoscopic cholecystectomy. Subtotal cholecystectomy may be needed in severe cases or those with cirrhosis due to thicker gallbladder walls and collateral vessels. Care must be taken to identify anatomy and avoid bile duct
This document provides an overview of head injuries, including definitions, surgical anatomy of relevant structures like the scalp, skull, meninges and brain, epidemiology, etiology, classifications, pathophysiology, clinical presentation, workup and management. It discusses different types of head injuries such as blunt and penetrating injuries, and classifications based on integrity of the dura mater, site of injury and pathology. Specific types of injuries like fractures, hematomas, and brain injuries are described in detail.
4 million people experience head trauma annually, with severe head injury being a leading cause of trauma death. Timely treatment is critical to prevent increased intracranial pressure from hemorrhages or edema, which can cause permanent brain damage or death. Signs of increased ICP include changes in vital signs, pupil reactivity, eye movements, muscle tone, and level of consciousness on the Glasgow Coma Scale. Early interventions like oxygen supplementation, ventilation support, and maintaining normal blood pressure and carbon dioxide levels are important to preserve brain perfusion and prevent further neurological injury.
Head injuries can range from minor cuts to serious conditions like concussions, contusions, hemorrhages or compression of the brain. Concussions involve temporary impairment of brain functions like thinking or vision from a blow to the head. Contusions cause bruising of the brain tissue which can lead to prolonged unconsciousness. Hemorrhages refer to bleeding within the skull from damaged blood vessels. Signs of a serious head injury include deep cuts, nausea, visual issues or unconsciousness. First aid involves protecting the airway, controlling bleeding from cuts and seeking immediate medical help.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
This document discusses head injuries, including their epidemiology, pathophysiology, types, and management. Head injuries are a major public health problem worldwide and are mostly caused by road traffic accidents and assaults. The main types of head injuries discussed are cerebral contusions, diffuse axonal injury, cerebral edema, traumatic intracranial hematomas such as extradural, subdural, subarachnoid and intracerebral hemorrhages, and concussions. Initial management focuses on preventing secondary brain damage through measures such as neurological observation, immobilization, intubation if needed, and transport to a dedicated neurological facility for patients with more severe injuries.
This document provides information about carcinoma of the esophagus, including its epidemiology, risk factors, pathological classification, clinical features, investigations, diagnosis and staging, and treatment. Carcinoma of the esophagus is most common in China, South Africa, and parts of India. It typically presents with dysphagia. Investigations include endoscopy with biopsy, imaging like CT and PET scans, and endoscopic ultrasound. Treatment depends on the stage, with surgery or chemoradiation used for early-stage or locally advanced carcinoma, and palliative approaches for metastatic disease.
This document provides an overview of traumatic brain injury (TBI), including its definition, pathophysiology, types (closed and open head injuries), specific injuries (contusions, hematomas, fractures), assessment (Glasgow Coma Scale), management (preventing secondary brain injury, ICP monitoring and treatment), and long-term outcomes (cognitive deficits, epilepsy, headaches). It describes the primary and secondary injury mechanisms of TBI, including diffuse axonal injury. Imaging and diagnostic criteria for different types of brain injuries are outlined. Guidelines for initial evaluation, monitoring, and medical and surgical management of increased ICP are also reviewed.
1. An epidural haematoma (EDH) is a collection of blood between the skull and the dura mater that is usually caused by an injury to the middle meningeal artery from a head trauma.
2. Symptoms of an EDH can include confusion, loss of consciousness, headaches, vomiting and neurological deficits. Patients may experience an initial lucid interval followed by deterioration in their mental status.
3. A CT scan is the primary method used to diagnose an EDH, which appears as a hyperdense, biconvex lesion between the skull and dura. Surgical evacuation is usually required for symptomatic EDHs, while small, asymptomatic EDHs may be monitored conservatively.
Head injuries can range from minor scalp injuries to serious traumatic brain injuries. Scalp injuries usually involve bleeding but are generally minor. Skull fractures occur when the skull breaks and can be simple cracks, multiple fractures, or depressed fractures where bones are displaced inward. Brain injuries are the most serious and can be closed injuries without skull fracture or open injuries where the skull is broken and brain membranes are breached. Common types of brain injuries include concussions, contusions which cause brain bruising, lacerations which tear brain tissue, and hematomas which are blood collections in the brain. The primary injury occurs initially from trauma while secondary injuries can develop over time from swelling and lack of oxygen delivery leading to increased pressure inside the skull. Prevention
This document provides information on head injuries. It begins by defining different types of head injuries from minor scalp lacerations to major trauma involving brain contusions and lacerations. It then discusses causes, presentations, investigations, management strategies and complications for various head injury types including skull fractures, epidural and subdural hematomas, subarachnoid hemorrhage, and intracerebral hemorrhage. Nursing management focuses on airway protection, maintaining cerebral perfusion, preventing secondary injuries, and supporting recovery.
Head injuries are commonly caused by motor vehicle accidents (44%) and falls (21%). Common types of head injuries include scalp wounds, skull fractures, and brain injuries such as contusions, hematomas, and hemorrhages. Symptoms vary depending on the location and severity of the injury but may include changes in consciousness, headache, vomiting, and motor or sensory deficits. Diagnostic tests like CT scans are used to evaluate the injury. Treatment focuses on stabilizing the patient, treating increased intracranial pressure through medications like mannitol, and surgical intervention if necessary.
A head injury can range from mild to severe and is caused by blunt force trauma or penetrating injuries to the skull and brain. Symptoms of a serious head injury include loss of consciousness, persistent headaches, vomiting, or abnormal behavior. Treatment depends on severity but may include monitoring for deterioration, supporting circulation and lowering intracranial pressure by evacuating hematomas or reducing brain swelling.
This document provides information about epidural hematoma (EDH):
- EDH is a collection of blood between the inner skull table and the dura mater caused by disruption of blood vessels due to head trauma.
- Symptoms range from confusion and headache to loss of consciousness. Immediate medical attention is required for moderate to severe head injuries.
- CT scan is the preferred imaging method and will show a hyperdense, biconvex hematoma confined by suture lines. MRI can also detect displaced dura.
- Small or chronic EDH under 1cm may be managed without surgery with close monitoring, while rapidly deteriorating patients or those with neurological deficits require urgent surgical evacuation of the hematoma
This document discusses head injuries, including:
- Definitions of head injury and traumatic brain injury as injuries resulting from trauma to the scalp, skull, or brain.
- Common causes are motor vehicle crashes, falls, assaults, and firearms.
- Injuries can be impact injuries from an object striking the head or acceleration/deceleration injuries from differential movement within the skull.
- Consequences can include scalp injuries, skull fractures, brain injuries like contusions and hematomas, and complications like infection, edema, and herniation. Proper management involves airway control, immobilization, monitoring, and treatment of raised intracranial pressure.
This document discusses classifications of traumatic brain injury (TBI). It describes several classification systems including:
- Glasgow Coma Scale (GCS) which grades severity as mild, moderate or severe.
- Mayo classification which defines moderate-severe TBI based on features like loss of consciousness over 30 minutes.
- Outcome-based classifications like Glasgow Outcome Scale which grades outcome on a scale from death to good recovery.
Pathophysiology of primary injury from mechanical forces and secondary injury from physiological changes are outlined. Initial stabilization priorities and neurological assessment techniques are also reviewed.
- Fine-needle aspiration cytology (FNAC) is the most important diagnostic tool for evaluating a solitary thyroid nodule, as it is safe, cost-effective, and reliable for differentiating between benign and malignant diseases of the thyroid. Ultrasound-guided FNAC is more accurate than palpation-guided.
- Thyroid imaging with ultrasound and radioactive iodine uptake scans can identify high-risk features that increase the likelihood of malignancy, such as hypoechogenicity, microcalcifications, irregular shape, and lack of iodine uptake in the nodule.
- Cytology results are categorized using the Bethesda or THY classification systems. Suspicious or malignant results
Head injuries are a common cause of mortality and morbidity in children. The document discusses various neurosurgical emergencies seen in children including head injury, hydrocephalus, brain tumors, intracranial bleeds, shunt complications, spinal cord injuries, and spinal cord compression. It provides details on the epidemiology, pathophysiology, etiology, anatomy, types of primary and secondary brain injury seen in pediatric head trauma. It also discusses evaluation and management of common neurosurgical emergencies in children such as head injury, intracranial bleeds, and spinal cord injuries.
Head injury types, clinical manifestations, diagnosis and managementVibha Amblihalli
Head injuries can range from minor scalp lacerations to major brain trauma. Common causes include motor vehicle accidents, falls, and sports injuries. Diagnosis involves CT or MRI imaging to identify fractures and intracranial bleeding. Treatment depends on injury severity but may include reducing intracranial pressure, surgical evacuation of hematomas, and preventing complications like seizures. Outcomes range from full recovery to permanent disability or death depending on the nature and extent of brain damage.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
The document discusses various types of thyroid tumors including cancer. It describes the normal anatomy and microscopic picture of the thyroid gland. The primary types of thyroid cancer are papillary, follicular, medullary, and anaplastic originating from the follicular epithelium or parafollicular cells. Risk factors include radiation exposure, family history, iodine deficiency, and thyroiditis. Evaluation involves history, examination, FNAC, ultrasound, and radiological investigations. Treatment depends on cancer type and involves surgery, radioactive iodine, and thyroxine therapy. Prognosis depends on age, tumor size and spread.
Osteochondroma is a benign bone tumor that projects from the external surface of bones. It consists of a cartilage cap and bony projection. Solitary osteochondroma involves one bone, while multiple osteochondromas can involve several bones and are associated with hereditary multiple exostosis. Osteochondromas are most common in children and adolescents, usually causing no symptoms, though sometimes pain or pressure on nearby tissues. While usually benign, osteochondromas have a small risk of malignant transformation. Diagnosis involves x-ray, CT or MRI to identify the connection to the underlying bone and cartilage cap structure. Symptomatic osteochondromas may require surgical excision to relieve symptoms.
This document provides an overview of head injury management, including definitions of key terms like the Glasgow Coma Scale and intracranial pressure. It describes mechanisms of traumatic brain injury and the evaluation of head injuries through history, exam, and radiographic imaging. It outlines guidelines for both nonoperative management, which typically involves monitoring and treating intracranial pressure, and operative management when significant mass lesions are present like epidural or subdural hematomas. The guidelines provide recommendations for indications for intracranial pressure monitoring and therapies to reduce elevated intracranial pressure through medical, surgical, and in more severe cases, barbiturate-induced coma interventions.
Osteosarcoma is a rare bone cancer that is most common in adolescents and older adults. It typically presents as a painful bone mass near the knee, upper arm, or thigh bone. Diagnosis involves imaging and biopsy of the tumor. Treatment consists of chemotherapy before and after surgery to remove the tumor, with the goal of complete resection. Post-treatment surveillance is important due to the risk of recurrence or metastasis, especially to the lungs. Prognosis depends on tumor stage, size, and response to initial chemotherapy.
1. The document discusses various types of head injuries including concussions, contusions, epidural hematomas, subdural hematomas, penetrating injuries, and blunt trauma injuries.
2. It provides definitions and descriptions of these injuries, their causes, signs and symptoms, diagnostic methods including CT and MRI scans, treatment approaches including surgery, and considerations in the emergency department.
3. The document is a reference for emergency medicine that covers classification, pathophysiology, clinical findings, radiographic findings, and management of different types of head injuries.
This document defines traumatic brain injury and describes the etiology, pathophysiology, classification, and management of head injuries. The most common causes of head injury are motor vehicle accidents, falls, assaults, and firearms. Injuries are classified as impact injuries resulting from an object striking the head or acceleration/deceleration injuries from differential movement within the skull. Primary injuries occur at impact and secondary injuries involve progressive brain damage. Complications can include increased intracranial pressure, brain swelling, infections, and long-term effects such as personality changes and dementia. Management involves stabilizing the patient, treating raised ICP, monitoring for complications, and long-term rehabilitation.
This document provides information about carcinoma of the esophagus, including its epidemiology, risk factors, pathological classification, clinical features, investigations, diagnosis and staging, and treatment. Carcinoma of the esophagus is most common in China, South Africa, and parts of India. It typically presents with dysphagia. Investigations include endoscopy with biopsy, imaging like CT and PET scans, and endoscopic ultrasound. Treatment depends on the stage, with surgery or chemoradiation used for early-stage or locally advanced carcinoma, and palliative approaches for metastatic disease.
This document provides an overview of traumatic brain injury (TBI), including its definition, pathophysiology, types (closed and open head injuries), specific injuries (contusions, hematomas, fractures), assessment (Glasgow Coma Scale), management (preventing secondary brain injury, ICP monitoring and treatment), and long-term outcomes (cognitive deficits, epilepsy, headaches). It describes the primary and secondary injury mechanisms of TBI, including diffuse axonal injury. Imaging and diagnostic criteria for different types of brain injuries are outlined. Guidelines for initial evaluation, monitoring, and medical and surgical management of increased ICP are also reviewed.
1. An epidural haematoma (EDH) is a collection of blood between the skull and the dura mater that is usually caused by an injury to the middle meningeal artery from a head trauma.
2. Symptoms of an EDH can include confusion, loss of consciousness, headaches, vomiting and neurological deficits. Patients may experience an initial lucid interval followed by deterioration in their mental status.
3. A CT scan is the primary method used to diagnose an EDH, which appears as a hyperdense, biconvex lesion between the skull and dura. Surgical evacuation is usually required for symptomatic EDHs, while small, asymptomatic EDHs may be monitored conservatively.
Head injuries can range from minor scalp injuries to serious traumatic brain injuries. Scalp injuries usually involve bleeding but are generally minor. Skull fractures occur when the skull breaks and can be simple cracks, multiple fractures, or depressed fractures where bones are displaced inward. Brain injuries are the most serious and can be closed injuries without skull fracture or open injuries where the skull is broken and brain membranes are breached. Common types of brain injuries include concussions, contusions which cause brain bruising, lacerations which tear brain tissue, and hematomas which are blood collections in the brain. The primary injury occurs initially from trauma while secondary injuries can develop over time from swelling and lack of oxygen delivery leading to increased pressure inside the skull. Prevention
This document provides information on head injuries. It begins by defining different types of head injuries from minor scalp lacerations to major trauma involving brain contusions and lacerations. It then discusses causes, presentations, investigations, management strategies and complications for various head injury types including skull fractures, epidural and subdural hematomas, subarachnoid hemorrhage, and intracerebral hemorrhage. Nursing management focuses on airway protection, maintaining cerebral perfusion, preventing secondary injuries, and supporting recovery.
Head injuries are commonly caused by motor vehicle accidents (44%) and falls (21%). Common types of head injuries include scalp wounds, skull fractures, and brain injuries such as contusions, hematomas, and hemorrhages. Symptoms vary depending on the location and severity of the injury but may include changes in consciousness, headache, vomiting, and motor or sensory deficits. Diagnostic tests like CT scans are used to evaluate the injury. Treatment focuses on stabilizing the patient, treating increased intracranial pressure through medications like mannitol, and surgical intervention if necessary.
A head injury can range from mild to severe and is caused by blunt force trauma or penetrating injuries to the skull and brain. Symptoms of a serious head injury include loss of consciousness, persistent headaches, vomiting, or abnormal behavior. Treatment depends on severity but may include monitoring for deterioration, supporting circulation and lowering intracranial pressure by evacuating hematomas or reducing brain swelling.
This document provides information about epidural hematoma (EDH):
- EDH is a collection of blood between the inner skull table and the dura mater caused by disruption of blood vessels due to head trauma.
- Symptoms range from confusion and headache to loss of consciousness. Immediate medical attention is required for moderate to severe head injuries.
- CT scan is the preferred imaging method and will show a hyperdense, biconvex hematoma confined by suture lines. MRI can also detect displaced dura.
- Small or chronic EDH under 1cm may be managed without surgery with close monitoring, while rapidly deteriorating patients or those with neurological deficits require urgent surgical evacuation of the hematoma
This document discusses head injuries, including:
- Definitions of head injury and traumatic brain injury as injuries resulting from trauma to the scalp, skull, or brain.
- Common causes are motor vehicle crashes, falls, assaults, and firearms.
- Injuries can be impact injuries from an object striking the head or acceleration/deceleration injuries from differential movement within the skull.
- Consequences can include scalp injuries, skull fractures, brain injuries like contusions and hematomas, and complications like infection, edema, and herniation. Proper management involves airway control, immobilization, monitoring, and treatment of raised intracranial pressure.
This document discusses classifications of traumatic brain injury (TBI). It describes several classification systems including:
- Glasgow Coma Scale (GCS) which grades severity as mild, moderate or severe.
- Mayo classification which defines moderate-severe TBI based on features like loss of consciousness over 30 minutes.
- Outcome-based classifications like Glasgow Outcome Scale which grades outcome on a scale from death to good recovery.
Pathophysiology of primary injury from mechanical forces and secondary injury from physiological changes are outlined. Initial stabilization priorities and neurological assessment techniques are also reviewed.
- Fine-needle aspiration cytology (FNAC) is the most important diagnostic tool for evaluating a solitary thyroid nodule, as it is safe, cost-effective, and reliable for differentiating between benign and malignant diseases of the thyroid. Ultrasound-guided FNAC is more accurate than palpation-guided.
- Thyroid imaging with ultrasound and radioactive iodine uptake scans can identify high-risk features that increase the likelihood of malignancy, such as hypoechogenicity, microcalcifications, irregular shape, and lack of iodine uptake in the nodule.
- Cytology results are categorized using the Bethesda or THY classification systems. Suspicious or malignant results
Head injuries are a common cause of mortality and morbidity in children. The document discusses various neurosurgical emergencies seen in children including head injury, hydrocephalus, brain tumors, intracranial bleeds, shunt complications, spinal cord injuries, and spinal cord compression. It provides details on the epidemiology, pathophysiology, etiology, anatomy, types of primary and secondary brain injury seen in pediatric head trauma. It also discusses evaluation and management of common neurosurgical emergencies in children such as head injury, intracranial bleeds, and spinal cord injuries.
Head injury types, clinical manifestations, diagnosis and managementVibha Amblihalli
Head injuries can range from minor scalp lacerations to major brain trauma. Common causes include motor vehicle accidents, falls, and sports injuries. Diagnosis involves CT or MRI imaging to identify fractures and intracranial bleeding. Treatment depends on injury severity but may include reducing intracranial pressure, surgical evacuation of hematomas, and preventing complications like seizures. Outcomes range from full recovery to permanent disability or death depending on the nature and extent of brain damage.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
The document discusses various types of thyroid tumors including cancer. It describes the normal anatomy and microscopic picture of the thyroid gland. The primary types of thyroid cancer are papillary, follicular, medullary, and anaplastic originating from the follicular epithelium or parafollicular cells. Risk factors include radiation exposure, family history, iodine deficiency, and thyroiditis. Evaluation involves history, examination, FNAC, ultrasound, and radiological investigations. Treatment depends on cancer type and involves surgery, radioactive iodine, and thyroxine therapy. Prognosis depends on age, tumor size and spread.
Osteochondroma is a benign bone tumor that projects from the external surface of bones. It consists of a cartilage cap and bony projection. Solitary osteochondroma involves one bone, while multiple osteochondromas can involve several bones and are associated with hereditary multiple exostosis. Osteochondromas are most common in children and adolescents, usually causing no symptoms, though sometimes pain or pressure on nearby tissues. While usually benign, osteochondromas have a small risk of malignant transformation. Diagnosis involves x-ray, CT or MRI to identify the connection to the underlying bone and cartilage cap structure. Symptomatic osteochondromas may require surgical excision to relieve symptoms.
This document provides an overview of head injury management, including definitions of key terms like the Glasgow Coma Scale and intracranial pressure. It describes mechanisms of traumatic brain injury and the evaluation of head injuries through history, exam, and radiographic imaging. It outlines guidelines for both nonoperative management, which typically involves monitoring and treating intracranial pressure, and operative management when significant mass lesions are present like epidural or subdural hematomas. The guidelines provide recommendations for indications for intracranial pressure monitoring and therapies to reduce elevated intracranial pressure through medical, surgical, and in more severe cases, barbiturate-induced coma interventions.
Osteosarcoma is a rare bone cancer that is most common in adolescents and older adults. It typically presents as a painful bone mass near the knee, upper arm, or thigh bone. Diagnosis involves imaging and biopsy of the tumor. Treatment consists of chemotherapy before and after surgery to remove the tumor, with the goal of complete resection. Post-treatment surveillance is important due to the risk of recurrence or metastasis, especially to the lungs. Prognosis depends on tumor stage, size, and response to initial chemotherapy.
1. The document discusses various types of head injuries including concussions, contusions, epidural hematomas, subdural hematomas, penetrating injuries, and blunt trauma injuries.
2. It provides definitions and descriptions of these injuries, their causes, signs and symptoms, diagnostic methods including CT and MRI scans, treatment approaches including surgery, and considerations in the emergency department.
3. The document is a reference for emergency medicine that covers classification, pathophysiology, clinical findings, radiographic findings, and management of different types of head injuries.
This document defines traumatic brain injury and describes the etiology, pathophysiology, classification, and management of head injuries. The most common causes of head injury are motor vehicle accidents, falls, assaults, and firearms. Injuries are classified as impact injuries resulting from an object striking the head or acceleration/deceleration injuries from differential movement within the skull. Primary injuries occur at impact and secondary injuries involve progressive brain damage. Complications can include increased intracranial pressure, brain swelling, infections, and long-term effects such as personality changes and dementia. Management involves stabilizing the patient, treating raised ICP, monitoring for complications, and long-term rehabilitation.
The document discusses head injury and traumatic brain injury (TBI). Some key points:
- Head injury is a common cause of emergency department visits, accounting for 3.4% of presentations. TBIs are a leading cause of death and disability, especially in young adults aged 15-24.
- Head injury ranges from mild concussion to severe brain injury resulting in death. Common causes are motor vehicle accidents, falls, firearms, and assaults.
- Primary brain injury occurs at impact, while secondary brain injury develops after from factors like hypoxia, hypotension, increased intracranial pressure, fever, seizures, and metabolic disturbances.
- Glasgow Coma Scale is used to assess head injury severity
1) Head injuries can cause primary brain injury at impact or secondary brain injury afterwards from factors like hypoxia or swelling.
2) Head injuries are classified by Glasgow Coma Scale from minor to severe. CT scans are used to identify fractures or bleeds in the brain.
3) Common brain injuries include extradural hematomas requiring urgent surgery, acute subdural hematomas also often needing surgery, and cerebral contusions monitored for swelling.
Traumatic brain injury (TBI) is caused by external force to the head resulting in brain dysfunction. Globally there are millions of TBI cases annually. The leading causes are road traffic incidents, falls, and assaults. In Rwanda, a study found an incidence of 234 TBIs per 100,000 people in Kigali, with the majority being mild TBIs from traffic accidents. Primary injuries occur at impact and secondary injuries can develop from factors like hypoxia and raised intracranial pressure. Imaging helps classify injuries as focal like fractures or contusions, or diffuse like diffuse axonal injury. The main clinical challenges are managing raised ICP and treating hematomas surgically if needed to prevent herniation.
This document provides information on head injuries, including definitions, etiology, pathophysiology, consequences, assessment, and management. The main causes of head injury are motor vehicle crashes, falls, assaults, and firearms. Head injuries can cause scalp lacerations, skull fractures, brain contusions and hemorrhages. Assessment involves the Glasgow Coma Scale and examining for neurological deficits. Initial management consists of airway control, immobilization, and monitoring vital signs. Treatments for elevated intracranial pressure include mannitol, furosemide, and midazolam.
- Head injuries are common presentations to the emergency department, representing up to 10% of visits. Common causes include road traffic accidents, falls, assaults, and sports injuries.
- CT head is the primary investigation to identify traumatic brain injuries and skull fractures. History should focus on mechanism of injury, time since injury, medications, and risk factors.
- Most head injuries are minor and can be safely discharged, but some serious underlying injuries can be missed if not properly evaluated. Patients require close monitoring for neurological changes that indicate deterioration.
TBI definion and their types well explainedHariSadu6
- Traumatic brain injury results from a primary impact injury and secondary injury in subsequent hours and days. Understanding intracranial pressure is key to minimizing secondary injury.
- Moderate and severe TBI require resuscitation per ATLS guidelines. A thorough history including mechanism of injury and neurological progression is important. Examination should check pupils, GCS, and spine.
- Common surgical pathologies include extradural hematoma, subdural hematoma, contusions, and diffuse axonal injury which can be seen on CT and require different management.
A head injury can range from minor to severe and life-threatening. It is classified as either closed, caused by blunt force, or penetrating, caused by an object breaking through the skull. The severity depends on factors like the force of impact and age of the individual. Serious head injuries require close monitoring for deterioration and may necessitate surgical intervention or reducing intracranial pressure to prevent further brain damage. Management involves stabilizing the patient, treating any brain injuries or swelling, and monitoring for complications that can arise from a head injury.
Head injuries can range from mild to severe depending on factors like loss of consciousness and Glasgow Coma Score. The document defines head injury and outlines classifications based on severity, mode, mechanism and pathology. It also discusses causes, clinical features, investigations and management of various types of brain injuries including concussion, contusion, lacerations and hematomas. Treatment involves initial assessment, resuscitation, monitoring, preventing secondary complications and surgery if needed to evacuate hematomas or repair skull fractures. Complications can include epilepsy, infections and chronic subdural hematomas if not properly treated.
HEAD INJURY- AN OVERVIEW
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on Head injury- an important topic in trauma because 50% of trauma deaths are due to head injuries. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of head injuries and management of all the varieties of head injuries. My aim is after watching this video all of you should be able to arrive at a correct working diagnosis of the type of head injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for watching the video.
This document discusses different types of head injuries, including primary and secondary brain injury. It classifies head injuries based on Glasgow Coma Scale and describes management of mild versus moderate to severe injuries. Surgical management is discussed for various intracranial hemorrhages like extradural hematoma, acute subdural hematoma, and cerebral contusions. Intracranial pressure monitoring and decompressive craniectomy are also mentioned for treatment.
1. The document discusses traumatic brain injuries and CNS infections, outlining their assessment, management, and surgical treatment.
2. Key points include evaluating patients using the Glasgow Coma Scale, identifying different types of intracranial hemorrhages on imaging and their presentations, and treating brain abscesses medically with antibiotics and surgically via burr hole aspiration or craniotomy for excision.
3. Surgical management of conditions like epidural hematomas and brain abscesses aims to decrease intracranial pressure and obtain samples for culture.
This document provides an overview of head injuries in children. It defines head injury as trauma to the scalp, skull, or brain from an external force. It discusses the epidemiology, mechanisms, types, assessment, management, and prevention of pediatric head injuries. The types of injuries include scalp injuries, skull fractures, and various types of brain injuries such as concussions, contusions, hemorrhages, and diffuse axonal injuries. Guidelines are provided for evaluating head injuries based on Glasgow Coma Scale and indications for referral, CT scan, and suspicion of non-accidental injury. The management of head injuries involves both medical and surgical approaches.
Head injuries can range from mild to severe depending on the Glasgow Coma Scale. The brain is covered by multiple layers of protection. Injuries can be closed or penetrating, and primary injuries occur at the time of impact while secondary injuries result from brain swelling and bleeding. Common causes include falls, assaults, and vehicle accidents. Treatment involves stabilizing the patient, examining for signs of intracranial bleeding or pressure, and managing complications like seizures. Surgery may be needed to evacuate hematomas.
The document discusses head injuries and traumatic brain injuries (TBI). It covers causes of TBI like falls and motor vehicle accidents. It then discusses the primary and secondary injuries that can occur from a TBI. It explains increased intracranial pressure and outlines treatments to control pressure like osmotic diuretics, CSF drainage, and fluid restriction. The document also covers assessing and diagnosing different types of brain injuries through imaging and examinations.
The document discusses head trauma and traumatic brain injury (TBI). It defines TBI as structural or physiological disruption of the brain from head injury. TBI can be closed or open head injuries and is classified by severity using the Glasgow Coma Scale. Common causes of TBI include falls, motor vehicle accidents, contact sports, and assaults. Types of primary brain injuries include intracranial hemorrhages, coup-contrecoup injuries, cerebral lacerations, and cerebral contusions. Secondary brain injuries can result from changes like increased intracranial pressure that affect oxygenation and blood pressure. Management of TBI involves treating primary and secondary injuries, including measures to control increased intracranial pressure.
This document provides an overview of the management of head injuries. It defines head injury as damage to the head from impact and classifies injuries as closed or open, diffuse or focal. The pathophysiology section explains how small increases in intracranial volume can raise pressure dramatically. Presentation may include altered consciousness, bleeding, seizures or vomiting. Investigations include CT scans to detect fractures or bleeds. Treatment focuses on preventing secondary injuries like hypoxia, controlling pressure, and maintaining perfusion and nutrition. Follow-up is needed as some patients with mild injuries may later develop complications.
Traumatic brain injury (TBI) is a major health problem in India, with over 1 million injuries and 200,000 deaths reported annually. The leading causes of TBI in India are road traffic accidents, which account for 60-70% of cases. Common types of TBI include concussions, skull fractures, and contusions. Initial treatment focuses on stabilizing the airway, breathing, and circulation, with diagnostic tests like CT scans used to further evaluate injuries. Management involves measures to reduce cerebral edema as well as medical therapies tailored to the specific injuries. Long-term rehabilitation is often needed to address physical, cognitive, and behavioral impairments resulting from TBI.
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2. DEFINITIONs
Head injuries include both injuries to the brain
and those to other parts of the head, such as
the scalp and skull
Trauma to the head causing neurological
manifestations.
Variable presentation
Head injury and traumatic brain injury(TBI) are
often used interchangeably
TBI encompasses broad range of pathological
injuries to the brain of varying clinical severity
that result from head trauma
3.
4. Thefowinggroupsofpatientsareat particularrisk:
• The elderly (risk of falls, cerebralatrophy)
• Infants (large head size, compressibleskull,
risk of non‐accidentalinjury)
• Patients with a bleeding diathesis (e.g.on
warfarin)
• Chronic alcoholics (at risk of falls and assaults,
cerebral atrophy, coagulopathy due to chronic
liver disease)
5. Some soberingfacts
• Traumatic brain injury (TBI) is still the major cause
of death under 45years of age.
Chirurg.2009 Feb;80(2):153‐64 [Diagnosis and treatmentof traumaticbraininjury.]
• Patients > or =65 years who survived mild TBI have
decreased functional outcome at 6 months
compared with younger patients
JTrauma.2004 May;56(5):1042‐8 The effectof age onfunctional outcome in mild traumatic brain injury:6‐month
report of a prospectivemulticentertrial.MosenthalAC et al.
• Female sex (particularly those age > or =55 y)
is associated independently with higher
mortalityin
isolated severeTBI
Am JSurg.2009 Feb;197(2):155‐8 Severe traumatic brain injury:is there a genderdifferencein mortality? Ottochian
M et al.
6. Anatomy andPhysiology
What are the unique features of
brain anatomy and physiology,
and how do they affect patterns
of brain injury?
7. Anatomy andPhysiology
Effects
● Rigid, non-expansile skull filled with
brain, CSF, and blood
● Cerebral blood flow (CBF)
usually autoregulated
● Autoregulatory compensation
disrupted by brain injury
● Mass effect of intracranial haemorrhage
8.
9. Layers of the Scalp
Five layers; the first three layers are bound together and move as a
unit
S-SKIN
C-Connective tissue,dense fibro-fatty ,contain scalp vessels,highly
vascularised, vessels don’t constrict its wall adherent to fibro fatty-
apply pressure
A-aponeurosis of galea
L- loose areolar layer,potential space,contain large amount of
bleed
P ericarinium
12. Secondary brain injury
Head injury
Systemic causes
Hypoxia
Hypo- or hypercarbia
Hypovolaemia
Hypo- or hypertension
Hypo- or hyperglycaemia
These are all preventable causes
13. Secondary brain injury
Head injury
Intracranial causes
Seizures
Cerebral oedema and raised intracranial
pressure (ICP)
Intracranial haematomas
These are all treatable causes
15. MONRO-KELLIE DOCTRINE
• The cranium is a “rigid box” and its total volume
remains constant.
• Increase in volume of the cranial compartments
(brain, blood and/or CSF) will elevate intracranial
pressure(ICP).
• If one of these three compartments increase in
volume,it must occur at the expense of volume
of the other two elements
16. • Normal intracranial pressure~ 0-10mmHg (5-18 cmH2O)
• Monro-Kellie Doctrine - "The total volume of intracranial
contents must remain constant"
• The cranial cavity: brain 1400gm, 75mL of blood, and
75mL of CSF.
• Addition of a mass e.g. a haematoma results in the
squeezing out of an equal volume of CSF & venous blood
to maintain the ICP.
• When this compensatory mechanism is exhausted, there
is an exponential increase in ICP for even a small
additional increase in the volume of the haematoma
18. Classificationofheadinjuries
By morphology
Diffuse injuries
These range from simple concussion with an excellent prognosisto
diffuse axonal injury with associated grimprognosis
Focal injuries
• Basal skull fractures have an associated risk of CSF leak.
• Clinical symptoms (eg, raccoon eyes, Battle’s sign, otorrhea,
and rhinorrhea) should increase the index of suspicion in
identifying basal skullfractures.
• Extradural
• Subdural
• Intracerebral
• Traumatic SAH
By clinical impact: GCSlevel
19. Head injuryclassificationin the
emergency department
A commonpresentation
• 80% Mild Head Injury = GCS 14 – 15
• 10% Moderate Head Injury = GCS 9 – 13
• 10% Severe Head Injury GCS = 3 – 8
20. GCS
GCS is used both for the initial assessment and
classification of closed head injuries and for
serial assessment of closed head injuries.
Initial GCS on admission to hospital is used to
classify head injuries into the broad prognostic
groups of mild (GCS 14-15), moderate (GCS 9-
13) and severe (GCS 3-8).
There is good quality evidence to relate initial
GCS score to outcome.
25. Extradural haemorrhage (aka
epidural hemorrhage)
Uncommon.
—Lenticular shaped opacity onCT
—Most commonly (80%) due to tearing of
middle meningeal artery due to a temporal
fracture
—Classically (i.e.<50%) have lucid period
after injury before subsequentlydeteriorating
(“talk and die”).
26. Concussions
Patients with mild head injuries typically
have concussions.
A concussion: physiologic injury to the brain
without any evidence of structural alteration.
postconcussive syndrome (PCS) (30%). PCS
consists of a persistence of any combination
of the following after a head injury:
headache, nausea, emesis, memory loss,
dizziness, diplopia, blurred vision, emotional
lability, or sleep disturbances
Concussions are graded on a scale of I-V.
27. Concussions: Grading
A grade I concussion: a person is confused temporarily but
does not display any memory changes.
In a grade II concussion, brief disorientation and
anterograde amnesia of less than 5 minutes' duration are
present.
In a grade III concussion, retrograde amnesia and loss of
consciousness for less than 5 minutes are present, in
addition to the 2 criteria for a grade II concussion.
Grade IV and grade V concussions are similar to a grade III,
except that in a grade IV concussion, the duration of loss of
consciousness is 5-10 minutes, and in a grade V
concussion, the loss of consciousness is longer than 10
minutes.
30. Subdural haemorrhage
More common
—especially in the presence ofcerebral
atrophy (e.g. elderly and alcoholics)
— Concave shaped on CT
—Dueto tearing of bridging veins draining
cerebral cortex.
— Maypresent as acute or chronic
37. Minor Head Injury‐Assessment
• Do the ABCDE’sinitially
• Initial period of clinical observation: at least 4hours
• Assess for riskfactors
• CT‐scan if GCS <15 at 2 hrs. post injury or any other RF detected
• (Consider) Admissionin present of any RF
• In case of doubt or deterioration consult neurosurgical service regarding
further management anddisposition
• D/Cwith head injury device at 4 hrs post injury if clinical improving with
either normal CT‐scan or noRF’s
38. RiskFactors
• Persistent GCS <15at 2hrs. postinjury
• Prolonged loss of consciousness (>5mins)
• Prolonged anterograde or retrograde amnesia (>30mins)
•
•
•
Post traumatic seizure
Focal neurological deficit
Clinical suspicion of skullFx
• Repeated vomiting (>2occasions)
• Persistent severeheadache
• Age > 65years
• Known coagulopathy
• Deterioration inGCS
• Multi systemtrauma
• Dangerous mechanism
• Intoxication
• Known neurological/neurosurgicalimpairment
• Delayed presentation
• Failure of clinicalimprovement
40. Indications forCT‐scan
• Mild head injury with at least 1 risk factor
present
• Any moderate headinjury
(9‐13)
• Any severe headinjury
(8 or less)
41. CTscan?
These patients should not routinely have CT
scanning if they have all of the following features:
All of...
On initial assessment:
•GCS 15 at two hours post injury
•No focal neurological deficit
•No clinical suspicion of skull fracture
•No vomiting
•No known coagulopathy or bleeding disorder
•Age <65 years
•No post traumatic seizure
•Nil or brief loss of consciousness (<5min)
•Nil or brief post traumatic amnesia (<30min)
•No severe headache
•No large scalp haematoma
•Isolated head injury
•No dangerous mechanism
•No known neurosurgery / neurological impairment
•No delayed presentation or representation.
After a period of observation (until at least four hours
post time of injury):
•GCS 15/15
•No post traumatic amnesia (A-WPTAS 18/18)
•Normal mental status including alertness, behaviour and
cognition.
•No clinical deterioration during observation.
•Clinically returning to normal
These patients should have early CT scanning if
available, if they have any of the following features:
Any of...
On initial assessment:
•GCS<15 at two hours post injury**
•Focal neurological deficit
•Clinical suspicion of skull fracture
•Vomiting
•Known coagulopathy or bleeding disorder
•Age >65
•Witnessed seizure
•Prolonged loss of consciousness (>5min)
•Prolonged post traumatic amnesia (>30min)
On serial assessment:
•Decrease in GCS
•Persistent GCS<15 at two hours post injury
•Persistent abnormal alertness/behaviour/cognition
•Persistent post traumatic amnesia (A-WPTAS<18/18)
•Persistent vomiting (≥2 occasions)
•Persistent severe headache
•Post traumatic seizure
Clinical judgement required if:
•Initial GCS 14 within two hours of injury**
•Large scalp haematoma or laceration
•Associated multi-system injuries
•Dangerous mechanism
•Known neurosurgery/neurological impairment
•Delayed presentation or representation
** NOTE: Includes patients with abnormal GCS due to
drug or alcohol ingestion.
42. Canadian CT Head Rule
• Rule
• Head CT not required if NONE of the following are present
• Age ≥ 65 years
• Vomiting > 2 time
• Suspected open or depressed Skull Fracture
• Signs suggesting basal skull fracture:
– Hemotympanum
– Racoon eyes
– CSF otorrhea or rhinorrhea
– Battle's sign (bruising around mastoid process)
• GCS < 15 at 2 hours post injury
• Retrograde Amnesia > 30min
• Dangerous mechanism
– Pedestrian struck by vehicle
– Ejection from motor vehicle
– Fall from elevation >3 feet or 5 stairs
43. Nice Guidelines
• • GCS less than 13 on initial assessment in the emergency department.
• • GCS equal to 13 or 14 at 2 hours after the injury on assessment in the emergency
department.
• • Suspected open or depressed skull fracture.
• • Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid
otorrhoea, Battle’s sign).
• • Post-traumatic seizure.
• • Focal neurological deficit. •
• More than one episode of vomiting.
• • Amnesia for greater than 30 minutes of events before impact
• CT with any of the following risk factors, provided they have experienced some loss of
consciousness or amnesia since the injury:
• • Age greater than or equal to 65 years.
• • Coagulopathy (history of bleeding, clotting disorder, current treatment with warfarin).
• • Dangerous mechanism of injury (a pedestrian struck by a motor vehicle, an occupant
ejected from a motor vehicle or a fall from a height of greater than 1 metre or five
stairs
44. • Plain X-rays of the skull have no role in the
diagnosis of significant brain injury. However,
they are useful as part of the skeletal survey
• Perform cervical spine radiographs if gcs is 8
or less
• Skull X-rays in conjunction with high-quality
in-patient observation also have a role
where CT scanning resources are
unavailable.
45. Standard carefor severe
HI
• Initial systematic assessment and resuscitation of ABCDEs.
• Early intubation.
• Supportive care of ABCDEs with appropriate attention to positioning (30°
head up), basic nursing care and avoidance of hyperventilation.
• Prevention of secondary brain injury by avoiding hypoxaemia (O2 saturation
<90%) and hypotension (systolic BP<90).
• Early CT scan to identify acute neurosurgical lesions.
• Early neurosurgical consult
• Early retrieval consult if transfer required
• Consider use of anticonvulsants to prevent early post traumatic seizures
• Consider ICP monitoring to guide management of cerebral perfusion
pressure.
• Low threshold to repeat CT scan if patient condition changes
• ICU admission
• Routine repeat CT scan at 24 hours
• Brain injury rehabilitation consult
• Minimum supportive care aims:
PaO2 > 60, SaO2 > 90, PaCO2 35 – 40, Systolic BP > 90, Head up 30°
46. Management of icp
• 1. Elevation of head 20-30 degrees
• To promote venous drainage from the head.
• 2.Ventilation o2 by mask
• Prevention of hypoxia and hypercapnia which increase ICP
• 3. Mannitol.
• i. Effective doses range from 0.25-1 gram/kg, given by intermittent bolus infusion
every 4-6 hrs.
• ii. Euvolemia must be maintained.
• iii. Monitor osmolality. Do not exceed 320mOsm/kg
• 4. Hyperventilation
• To blow out the co2 and reduce hypercapnia and maintain pCO2 of 30-35 mmHg
• 5. Hypertonic Saline
• 6. Anticonvulsant therapy
• Phenytoin is used to prevent or control seizure activity that increases cerebral
blood flow and subsequently intracranial pressure. Anticonvulsant medications
should be used for 1 wk
47. Management of icp…
• 7. Nimodipine
• The calcium channel blocker reduces death and severe disability
when instituted acutely in patients with head injuries.
• 8. Relieve and prevent pyrexia which increases intracranial
pressure. eg NSAIDS Provision of .analgesia has similar effects
• 9.Sedatives
• High dose diazepam may be considered for hemodynamically
stable, salvageable, severe head injury patients with intracranial
hypertension refractory to maximal medical and surgical therapy.
Other narcotics may depress respiration
• 10. Steroids Dexamethasone use is controversial in head injury
• 11. decompressive craniectomy
48. Blood Pressure Management in
Traumatic Brain Injury
• high systemic blood pressure after TBI center around a catecholamine
excess state, elevation in intracranial pressure (ICP)
• may be protective to a point, by maintaining CPP
• may also cause secondary brain damage by aggravation of vasogenic
edema and intracranial hypertension, potentially as a result of
increased hydrostatic capillary pressure in the brain
• Early hypotension has been linked with poor outcomes following
severe TBI, and guidelines suggest early and aggressive management
of hypotension after TBI.
• Despite these recommendations, no guidelines exist for the
management of hypertension after severe TBI,
• Focus of care after traumatic brain injury is maintenance of CPP
• Treatment of acute hypertension in TBI is not recommended
• However, ideal CPP(60-70, ICP<20, MAP 80>90
50. The Depressed Skull Fracture
Simple depressed fractures in neurologically intact infants are treated
expectantly. These depressed fractures heal well and smooth out with time,
without elevation.
Open fractures, if contaminated, may require antibiotics in addition to tetanus
toxoid.
Surgical elevation If:
• evidence of dural penetration,
• significant intracranial hematoma,
• depression >50%,
• depression greater than 1 cm
• frontal sinus involvement,
• gross cosmetic deformity,
• wound infection or gross wound contamination
• pneumocephalus,.
51. Complications of head injury.
• CN palsies and Focal neurological signs
• Hydrocephalus
• Convulsive disorder/epilepsy
• Psychiatric disorders
• Cerebrospinal fluid fistulae, either in the form of
rhinorrhea or otorrhea
• Posttraumatic movement disorders Tremor,
dystonia, parkinsonism, myoclonus
• Vascular injuries
• Speech disorders
52. Controversies/ RCT Findings
There are currently no convincing data to support infection prophylaxis in
patients with TBI, especially in light of data suggesting that prophylaxis
might predispose patients to more severe infections when infections would
arise
Currently available evidence from RCTs does not support prophylactic
antibiotic use in patients with basilar skull fractures, whether there is
evidence of CSF leakage or not. Antibiotics have not been shown to
decrease the risk of meningitis in patients with base of skull fractures with
or without CSF leaks
current literature guidelines indicates that the incidence of early PTS
appears to be reduced with the addition of prophylactic antiseizure
medications. However, there is currently no evidence to indicate that
prophylactic antiseizure medications alter mortality or incidence of late
PTS, and it is still unknown whether or not this course of therapeutic
prophylaxis is currently benefitting patients
Based on the results of the CRASH trial, steroids should not be used
routinely in the treatment of acute traumatic head injury, as they appear to
increase mortality.
53. To Read:
’
Cushing s response – bradycardia , irreggular
respiration and hypertension
CEREBRAL HERNIATION SYNDROMES
KERNOHAN’S NOTCH
Benefit and harm of treating high blood
pressure in TBI patients
external ventricular drainage (EVD)
systems