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    Head Trauma: Initial Assessment and Management

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    i wayan dediyana
    The document discusses the initial assessment and management of head trauma. It covers classifying head injuries based on severity using the GCS score, describing common brain injuries like epidural hematomas and evaluating patients with CT scans. The priorities in managing severe head injuries are controlling ICP, minimizing secondary brain injury through oxygenation, ventilation, blood pressure control and early neurosurgery if indicated.

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    Head Trauma: Initial Assessment and Management

    Uploaded by

    i wayan dediyana
    299 views38 pages
    The document discusses the initial assessment and management of head trauma. It covers classifying head injuries based on severity using the GCS score, describing common brain injuries like epidural hematomas and evaluating patients with CT scans. The priorities in managing severe head injuries are controlling ICP, minimizing secondary brain injury through oxygenation, ventilation, blood pressure control and early neurosurgery if indicated.

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    penanganan trauma kepala

    Original Title

    Head Trauma

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    The document discusses the initial assessment and management of head trauma. It covers classifying head injuries based on severity using the GCS score, describing common brain injuries like epidural hematomas and evaluating patients with CT scans. The priorities in managing severe head injuries are controlling ICP, minimizing secondary brain injury through oxygenation, ventilation, blood pressure control and early neurosurgery if indicated.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    299 views38 pages

    Head Trauma: Initial Assessment and Management

    Uploaded by

    i wayan dediyana
    The document discusses the initial assessment and management of head trauma. It covers classifying head injuries based on severity using the GCS score, describing common brain injuries like epidural hematomas and evaluating patients with CT scans. The priorities in managing severe head injuries are controlling ICP, minimizing secondary brain injury through oxygenation, ventilation, blood pressure control and early neurosurgery if indicated.

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    Download as pptx, pdf, or txt
    of 38

    Head Trauma

    Initial Assessment and Management


    Case Scenario

    ● 58-year-old male fell from a second-story roof


    in a small rural town
    ● Initial GCS score = 12
    ● On admission after 2-hour transfer, GCS score
    is 6

    What injuries would you suspect?


    What are your priorities in
    managing this patient?
    Objectives
    1. Describe basic intracranial physiology.
    2. Evaluate and classify head injury patients
    based on severity.
    3. Explain the importance of adequate
    resuscitation in limiting secondary brain
    injury.
    Anatomy and Physiology

    What are the


    unique features of
    brain anatomy and
    physiology, and
    how do they affect
    patterns of brain
    injury?
    Anatomy and Physiology

    What are the unique features of brain


    anatomy and physiology, and how do they
    affect patterns of brain injury?

    • Rigid, nonexpansile skull filled with brain,


    CSF, and blood
    • Cerebral blood flow (CBF) usually
    autoregulated
    • Autoregulatory compensation disrupted by
    brain injury
    • Mass effect of intracranial hemorrhage
    Monro-Kellie Doctrine
    Volume-Pressure Curve
    Intracranial Pressure (ICP)

    10 mm Hg = Normal
    >20 mm Hg = Abnormal
    >40 mm Hg = Severe

    • Sustained increased ICP leads to decreased


    brain function and poor outcome
    • Hypotension and low saturation adversely
    affect outcome
    Classifications of Head Injury
    By Morphology – Skull Fractures

    Vault
    • Depressed or nondepressed

    • Open / closed

    Basilar
    • With or without CSF leak
    • With or without cranial nerve palsy
    Classifications of Head Injury
    By Morphology – Brain Injuries

    Focal
    • Epidural (extradural)
    • Subdural
    • Intracerebral

    Diffuse
    • Concussion
    • Multiple contusions
    • Hypoxic / ischemic injury
    Epidural Hematoma

    • Associated with skull


    fracture
    • Classic: middle
    meningeal artery tear
    • Lenticular / biconvex
    • Lucid interval
    • Can be rapidly fatal
    • Early evacuation
    essential Uncal herniation
    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
    Intracerebral Hematoma / Contusion

    • Coup / contra coup


    injuries
    • Most common:
    frontal / temporal
    lobes
    • CT changes usually
    progressive
    • Most conscious
    patients: no
    operation
    Large Frontal Contusion with Shift
    Diffuse Brain Injury

    Normal CT Diffuse Injury

    Range from mild concussion to severe


    ischemic insult
    Classifications of Head Injury
    By Severity of Injury Based on GCS Score

    • Mild
    • Moderate
    • Severe
    Mild Brain Injury
    • GCS score = 13 – 15
    • History
    • Exclude systemic injuries
    • Neurologic exam
    • Radiographic investigation as
    indicated
    • Alcohol / drug screens as indicated

    Observe or discharge based on findings


    Moderate Brain Injury

    • GCS score = 9 – 12
    • 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
    Severe Brain Injury

    • GCS score = 3 – 8
    • Evaluate and resuscitate
    • Intubate for airway protection
    • Neurologic exam prior to intubation
    • Focused neurologic exam
    • Frequent reevaluation
    • Identify associated injuries
    Indications for CT Scan

    • GCS score still < 15 two


    hours after injury
    • Neurologic deficit
    • Open skull fracture
    • Sign of basal skull
    fracture
    • Vomiting (> 2 episodes)
    • Extremes of age
    • Retrograde amnesia
    • Severe headache
    Management

    What is the optimal treatment for


    patients with brain injuries?
    Management

    What is the optimal treatment for


    patients with brain injuries?
    Priorities
    • ABCDE
    • Minimize secondary brain injury
    • Administer oxygen
    • Maintain adequate ventilation
    • Maintain blood pressure
    (systolic > 90 mm Hg)
    Management
    What is a focused neurological
    examination?
    Management
    What is a focused neurological
    examination?
    • GCS score
    • Pupils
    • Lateralizing signs

    Consult neurosurgeon early


    Management

    Medical

    • Controlled ventilation
    • Goal: PaCO2 at 35 mm Hg
    • Intravenous fluids
    • Euvolemia
    • Isotonic
    • Consult with neurosurgeon
    Management
    Medical

    • Mannitol
    • Use only with signs of tentorial
    herniation
    • Avoid in patients with hypovolemia
    • Dose 1.0 gram / kg IV bolus
    • Hypertonic saline
    • Anticonvulsants
    • Sedation Neurological examination
    before prolonged
    • Paralytics sedation/paralysis
    Management
    Surgical

    • Scalp Wounds
    • Possible site of major blood loss
    • Direct pressure to control bleeding
    • Occasional temporary closure
    Management
    Surgical

    • Penetrating Trauma
    • ABCs
    • X-ray / CT scan
    • Early neurosurgical consult
    • Prophylactic antibiotics
    • Do not remove penetrating object or
    probe the wound.
    Management
    Surgical

    • Intracranial Mass Lesion


    • Can be life-threatening if expanding
    rapidly
    • Immediate neurosurgical consult
    • Hyperventilation / medical therapy
    • Damage control craniotomy: transfer
    to neurosurgeon (rural / austere areas)
    Brain Death
    How do I diagnose brain death?
    Brain Death
    How do I diagnose brain death?
    • GCS score = 3
    • Nonreactive pupils
    • Absent brainstem reflexes
    • No spontaneous ventilatory effort
    on formal apnea testing
    Case Scenario

    ● 58-year-old male fell from a second-story


    roof in a small rural town
    ● Initial GCS score = 12
    ● On admission after 2-hour transfer, GCS
    score is 6

    What injuries would you suspect?


    What are your priorities in
    managing this patient?
    Questions?
    Summary

    ● Management of head injuries requires an


    understanding of basic intracranial physiology.
    ● Efficient evaluation of head and brain injuries
    includes ABCs, a neurologic examination and
    searching for associated injuries.
    ● Adequate resuscitation is important in limiting
    secondary brain injury.

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