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Traumatic brain injury

summary from Brain Trauma Foundation
FAcebook: happy Friday knight

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Traumatic brain injury

  1. 1. Surgical Management of Traumatic Brain Injury – Brain Trauma Foundation Severity of TBI: Mild: GCS 13 – 15 Moderate: GCS 9 – 12 Severe: GCS 3 - 8 Facebook: ศุกร์ศัลย์ – Happy Friday Mechanism of TBI: Blunt, penetrating, blast CT brain findings: EDH: MMA in origin, lucid interval, well-defined biconvex hyperdense collection aSDH: laceration of bridging vein, crescent hydense collection Subacute SDH: 3 days, isodense cSDH: hypodense tSAH: disruption of small pia vessels, hyperdense serpentine lesion of sylvian fissure, interpeduncular cistern (aSAH: thickest at circle of Willis) DAI: small petechial hemorrhage at grey-white junction Contusion: fluffy inhomogenous adjacent to bony prominence ICH: well-defined border Preoperative preparation: MAP > 70 mmHg, euthermia, PaCO2 35 – 40 mmHg, PaO2 95 – 100 mmHg, O2sat > 93%, Na 135 – 145 mEq, ETT, if present focal neurological sign: hyperventilation keep PaCO2 30-32, mannitol 0.25 – 1 g/kg Surgical Indications: - ICP > 22 mmHg - aEDH: > 30 cm3, > 15 mm thick, > 5 mm midline shift - aSDH: > 10 mm thick, > 5 mm midline shift - Depressed skull fx: skull depressed thicker than thickness of cranium, dural penetration, significant ICH, depress > 1 cm, frontal sinus involvement, cosmetic, infection, gross contamination, pneumocephalus Goal of treatment: prevention of secondary brain insult (hypoxia) Intial management: Moderate to severe TBI: resuscitation, CT brain, consult neurosurgeon Mild TBI: describe in low, moderate, high risk Mild TBI, high risk: CT brain Moderate risk: CT or admit observe Low risk: discharge with instruction