6. SKULL AND MENINGES
American college of surgeons committee on trauma. ATLS student course manual. 10th ed. Chicago: American
college of surgeons, 2018.
7. BRAIN AND VENTRICULAR SYSTEM
American college of surgeons committee on trauma. ATLS student course manual. 10th ed. Chicago: American
college of surgeons, 2018.
28. CEREBRAL EDEMA
• Midline shift
• Slit ventricle
• Herniation
• Loss of sulci
• Loss of grey-white junction
29. TREATMENT
• According to severity
• Mild head injury: low, moderate, high risk
• Moderate to severe head injury
• ABCDEs
• Resuscitation and protect airway in severe head injury
• CT brain with C-spine
30. MILD TBI: LOW RISK
• GCS 15
• Asymptomatic
• No headache
Discharge with instruction
31. MODERATE TO HIGH RISK
MILD TBI
• Moderate risk
• CT brain and observe 6 h
• admit
• High risk
• CT brain + admit
34. MEDICATION: DILANTIN
• Early posttraumatic seizure prophylaxis
• 7 days to 2 years if seizure presents
• 15 – 20 mg/kg IV in 30 min, then 100 mg q8h x 7 days
35. • Indications:
• Immediate posttraumatic seizure or history of seizure
• Posttraumatic amnesia > 30 min
• GCS ≤ 10
• Linear or depressed skull fracture
• Penetrating head injury
• Hemorrahge: EDH, SDH, SAH, ICH, IVH, contusion
• Chronic alcoholism
MEDICATION: DILANTIN
36. TIME TO SURGERY
• EDH
• 30 cm3
• Thickness > 15 mm
• Midline shift > 5 mm
37. TIME TO SURGERY
• SDH
• > 10 mm thick
• > 5 mm midline shift
• GCS drop > 2
• Asymmetric pupil
• ICP > 20 mmHg
40. TIME TO SURGERY
• Depressed skull fracture
• Depress more than thickness of cranium or > 1 cm
• Dural penetration
• Significant intracranial hemorrhage
• Frontal sinus involvement
• Cosmetic
• Infection and contamination
• Pneumocephalus
41.
42. REFERENCES
American college of surgeons committee on trauma. ATLS student course manual. 10th
ed. Chicago: American college of surgeons, 2018.
Carney N et al. Guidelines for the Management of Severe Traumatic Brain Injury,
Fourth Edition. 2016
Anzai Y et al. Imaging of traumatic brain injury. New York: WL, 2015.
Winn, H. Richard. Youmans and Winn’s Neurological Surgery. Phildelphia: Elsevier,
2017.