Head Trauma Flashcards
(17 cards)
What proportion of patients with GCS <8 have a surgical lesion
25%
What proportion of patients with a head injury have a C-spine injury?
5% (usually C1-3)
What are the main causes of a secondary brain injury following trauma?
These are injuries that develop subsequent to the trauma e.g. hypoxia, raised ICP, vasospasm, lowcerebral perfusion, acidosis, metabolic derangements etc
What are the delayed complications following head trauma?
Delayed bleed Hydrocephalus Infection Diffuse cerebral oedema Pneumocephalus Seizures Metabolic disturbances Adrenal insufficiency Drug / ETOH withdrawl Carotid dissection
How are head injuries graded?
GCS14-15 - mild
9-13 - moderate
What is the effect of hypotension following head trauma on prognosis?
Doubles the risk of mortality
What are the recommendations for BP parameters following head injury in the acute setting?
Keep systolic >90 mmHg
What are the indications for intubation following head injury?
GCS
What is the effect of antibiotics following intubation?
Reduces the chance of pneumonia but does not reduce ICU stay
What are the guidelines for hyperventilation following head injury?
Keep above 4 KPa
What are the complications of hyperventilation?
Cerebral ischaemia
Alkalosis results in hypocalcaemia and tetany
What are the indications for mannitol in the emergency setting?
Signs of raised ICP (blown pupil etc)
Evidence of mass effect
Raised ICP on imaging
To assess salvageability (response to mannitol prior to definite surgical intervention)
What is the dose of mannitol in the acute settting?
0.5-1g/kg e.g. 350ml of 20%
What is the time to peak effect of mannitol?
20 mins
What is the evidence of AEDs following TBI?
Reduces the risk of early seizures but not delayed PTS and does not effect outcome therefor discontinue after 7/7
What are the mechanisms of action of mannitol?
Immediate reduction in ICP through autoregulatory vasoconstriction due to changes in blood rheology. Delayed effect as an osmotic diuretic.
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