Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Head trauma for general practitioners

facebook: happy Friday knight

Head trauma for general practitioners

  1. 1. HEAD TRAUMA FOR GENERAL PRACTITIONERS HAPPY FRIDAY KNIGHT
  2. 2. OUTLINES • Anatomy review • Physiology review • Classifications of head injuries • Investigation: CT brain • Treatment guidelines
  3. 3. INTRODUCTION • Primary goal treatment is to prevent secondary brain insult • CT brain should not delay patient transfer to a trauma center
  4. 4. ANATOMY REVIEW • Scalp • Skull • Meninges • Brain • Ventricular system
  5. 5. SCALP galea Subgaleal connective tissue https://teachmeanatomy.info/head/areas/scalp/
  6. 6. SKULL AND MENINGES American college of surgeons committee on trauma. ATLS student course manual. 10th ed. Chicago: American college of surgeons, 2018.
  7. 7. BRAIN AND VENTRICULAR SYSTEM American college of surgeons committee on trauma. ATLS student course manual. 10th ed. Chicago: American college of surgeons, 2018.
  8. 8. https://www.sciencedirect.com/topics/neuroscience/ventricular-system
  9. 9. Reilly P. Management of intracranial pressure and cerebral perfusion. Head injury. London, 1997.
  10. 10. PHYSIOLOGY REVIEW: MONROE-KELLIE DOCTRINE • Vother: volume of any abnormal component  hematoma, tumor • Cranium is • Nonexpandable • incompressible
  11. 11. CEREBRAL BLOOD FLOW • CPP = MAP - ICP • Pressure autoregulation: MAP 50-150 mmHg is autoregulated to maintain constant CBF
  12. 12. CLASSIFICATION OF HEAD INJURIES • Severity • Morphology • Intracranial lesion
  13. 13. HOW TO READ CT BRAIN • ABCDEF • A – airspaces: pneumocephalus, trauma or sinus • B – blood, bone, brain • C – CSF • D – Dura • E – eyes • F - face
  14. 14. Anzai Y et al. Imaging of traumatic brain injury. New York: WL, 2015.
  15. 15. EPIDURAL HEMATOMA • Lens shape • Hyperdensity • Lucid interval • Injury to middle meningeal a. • Coup lesion Anzai Y et al. Imaging of traumatic brain injury. New York: WL, 2015.
  16. 16. SUBDURAL HEMATOMA • Tear bridging vein • Countercoup lesion • Crescent shape • Acute • < 1day • hyperdensity • Subacute • 1-3 days • Isodense • Chronic • Hypodense with septation
  17. 17. SUBARACHNOID HEMORRHAGE • Traumatic: Serpentine hyperdense lesion along sulci • Aneurysmal: maximum thickness at basal cistern
  18. 18. INTRAVENTRICULAR HEMORRHAGE
  19. 19. CEREBRAL CONTUSION • Fluffy appearance • Mixed hypo-hyperdense, inhomogenous • Ill-defined border • Adjacent to bony prominence
  20. 20. INTRACEREBRAL HEMORRHAGE • Well-defined borde • More homogenous
  21. 21. CEREBRAL CONCUSSION • GCS = 15 • No neurodeficit after recovery
  22. 22. DIFFUSE AXONAL INJURY • Unconscious > 24 hr • Spot hemorrhage along grey-white matter junction
  23. 23. CEREBRAL EDEMA • Midline shift • Slit ventricle • Herniation • Loss of sulci • Loss of grey-white junction
  24. 24. 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
  25. 25. MILD TBI: LOW RISK • GCS 15 • Asymptomatic • No headache Discharge with instruction
  26. 26. MODERATE TO HIGH RISK MILD TBI • Moderate risk • CT brain and observe 6 h • admit • High risk • CT brain + admit
  27. 27. MEDICATIONS: MANNITOL • Indication: signs of herniation, ICP > 22 mmHg • 20% mannitol 0.25 – 1 g/kg IV in 15 min, then 100 mg IV q8h
  28. 28. 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
  29. 29. • 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
  30. 30. TIME TO SURGERY • EDH • 30 cm3 • Thickness > 15 mm • Midline shift > 5 mm
  31. 31. TIME TO SURGERY • SDH • > 10 mm thick • > 5 mm midline shift • GCS drop > 2 • Asymmetric pupil • ICP > 20 mmHg
  32. 32. TIME TO SURGERY • SAH • When hydrocephalus presents
  33. 33. TIME TO SURGERY • ICH • > 30 cm3
  34. 34. 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
  35. 35. 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.

×