summary from Brain Trauma Foundation FAcebook: happy Friday knight

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