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    Head Trauma: Kelompok 2: Andry Wongso Rhiza M.I.S Terri S. S Priscilla

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    Jenadi Binarto
    This document summarizes guidelines for managing head trauma. It discusses increased intracranial pressure, classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale scores, common intracranial lesions including epidural hematomas, subdural hematomas and diffuse axonal injuries. It outlines the assessment, diagnostic workup and management goals for head injuries, including maintaining brain metabolism and preventing secondary injuries. Specific management strategies are provided for mild, moderate and severe head injuries, including the use of intravenous fluids, hyperventilation, mannitol and anticonvulsants.

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    Head Trauma: Kelompok 2: Andry Wongso Rhiza M.I.S Terri S. S Priscilla

    Uploaded by

    Jenadi Binarto
    29 views22 pages
    This document summarizes guidelines for managing head trauma. It discusses increased intracranial pressure, classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale scores, common intracranial lesions including epidural hematomas, subdural hematomas and diffuse axonal injuries. It outlines the assessment, diagnostic workup and management goals for head injuries, including maintaining brain metabolism and preventing secondary injuries. Specific management strategies are provided for mild, moderate and severe head injuries, including the use of intravenous fluids, hyperventilation, mannitol and anticonvulsants.

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    head trauma, penurunan kesadaran

    Original Title

    Head Trauma - Kelompok 2

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    This document summarizes guidelines for managing head trauma. It discusses increased intracranial pressure, classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale scores, common intracranial lesions including epidural hematomas, subdural hematomas and diffuse axonal injuries. It outlines the assessment, diagnostic workup and management goals for head injuries, including maintaining brain metabolism and preventing secondary injuries. Specific management strategies are provided for mild, moderate and severe head injuries, including the use of intravenous fluids, hyperventilation, mannitol and anticonvulsants.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    29 views22 pages

    Head Trauma: Kelompok 2: Andry Wongso Rhiza M.I.S Terri S. S Priscilla

    Uploaded by

    Jenadi Binarto
    This document summarizes guidelines for managing head trauma. It discusses increased intracranial pressure, classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale scores, common intracranial lesions including epidural hematomas, subdural hematomas and diffuse axonal injuries. It outlines the assessment, diagnostic workup and management goals for head injuries, including maintaining brain metabolism and preventing secondary injuries. Specific management strategies are provided for mild, moderate and severe head injuries, including the use of intravenous fluids, hyperventilation, mannitol and anticonvulsants.

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    © All Rights Reserved
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    of 22

    HEAD TRAUMA

    Kelompok 2:
    Andry Wongso
    Rhiza M.I.S
    Terri S. S
    Priscilla
    Pembimbing:
    Prof. Dr. dr. M. Z. Arifin, SpBS (K)

    Intracranial Pressure
    Pressure / Volume Curve
    ICP

    Herniation

    10 point of decompensation
    volume of mass

    keep the patients pressure & volume


    in the flat portion of the curve, rather
    than to treat the patient at the point of
    decompensation

    Increased Intracranial Pressure( IICP )


    Result in

    Decreased cerebral perfusion


    pressure ( CPP )
    CPP

    : Mean Arterial Blood

    PressureICP

    Altered level of consciousness

    Classification of Head Injury


    - Mechanism of injury

    Blunt:
    automobile collision, fall & assault

    Penetrating:
    gunshot wounds, other penetrating
    injuries

    - Severity

    Mild:

    GCS score 14 ~ 15

    Moderate:

    GCS score 9 ~13

    Severe:

    GCS score 3 ~ 8

    Skull fractures

    Vault:
    linear / stellate,
    depressed / nondepressed,
    open / close
    Basilar (diagnosed by CT bone window):
    raccoon eyes, Battles signs
    (retroauricular ecchymosis),
    CSF leakage and 7th nerve palsy

    Intracranial Lesions
    Focal lesions:
    Epidural hematoma:
    most due to tearing of the middle meningeal artery
    prognosis is usually excellent ( underlying brain
    injury is limited )
    CT: biconvex or lenticular in shape
    Pitfalls: classical lucid interval and talk and die

    Intracranial Lesions
    Focal lesions
    Subdural hematoma:
    brain damage much more & prognosis is much
    worse than EDH
    tearing of a bridging vein

    Focal lesions
    Contusions and intracerebral hematomas:
    most occur in the frontal & temporal
    lobes
    always seen in association with SDH

    Intracranial Lesions
    Diffuse injuries
    Mild concussion: temporary neurologic dysfunction,
    confusion & disorientation without or with amnesia
    Classic cerebral concussion:
    1.Transient & reversible loss of consciousness, returns
    to full consciousness by 6 hrs.
    2.No sequelae other than amnesia for the events
    3.post-concussion syndrome: memory difficulties,
    dizziness, nausea, anosmia & depression

    Intracranial Lesions
    Diffuse injuries:
    Diffuse axonal injury ( DAI )
    1.prolonged postraumatic coma that
    is not due to a mass lesion or
    ischemic insults
    2.usually having decortication or
    decerebation posture
    3.autonomic dysfunction:
    hypertension, hyperhidrosis &
    hyperpyrexia

    Assessment of Head injury


    History
    Mechanism of injury
    Pre and post injury status
    Document / communicate
    Reassess

    Vital Signs
    Identifies neurologic & systemic status
    Presume hypotension due to hypovolemia,
    not head injury

    Minineurologic Exam
    Purpose
    Determine severity of brain injury
    Detect deterioration
    Categories injuries

    Level of consciousness - GCS


    eye opening
    verbal
    motor
    Pupil
    Motor lateralization ( mass lesion )

    Minineurologic Exam
    Pupils
    Size
    Equality
    Briskness of response
    Anormal: >1 mm difference in size
    Extremity Movement
    Equality
    Pain response
    Lateralized weakness - mass lesion

    Diagnostic Procedure

    CT:
    be obtained in all head -injury patients ( ideally ), especially there
    is a history of more than a momentary loss of consciousness,
    amnesia or severe headaches
    C-Spine
    Alcohol level & urine toxic screen
    Skull X-ray:
    penetrating head injury or when CT scan is not immediately
    available

    Head injury Management


    Goal:
    To prevent secondary damage
    to an already injuried brain
    Management Goals
    Establish diagnosis
    Assure brain metabolism & prevent
    secondary brain injury
    Consult Neurosurgen early or early transfer

    Head injury Management


    Management of Mild head injury
    Normal CT :
    1. Brought back to ER if need ( Head- injury warning
    discharge
    instructions )
    2. No companion ==> Admission or
    observe at ER
    Abnormal CT : Admission

    Head-injury Warning discharge


    Instruction

    Drowsiness or increasing difficulty in awaking patient ( Awaken patient


    every 2 hrs )
    Nausea or Vomiting
    Convulsion or fits
    Bleeding or Watery discharge from the nose or ear
    Severe headache
    Weakness or loss of feeling in the arm or leg
    Confusion or strange behavior
    One pupil larger than the other, double vision or visual disturbance
    Very slow or very rapid pulse, or an unusual breathing pattern

    Head injury Management


    Management of Moderate Head Injury
    GCS 9 ~ 13
    All need brain CT
    All need to be admitted, even if CT
    scan is normal

    Head injury Management


    Management of Severe Head Injury
    GCS 3 ~ 8
    Prompt diagnosis & treatment is of utmost import ( wait and see =
    disastrous )
    Primary survey : Cardiopulmonary stabilization be achieved rapidly
    Secondary survey : >= 50 % had additional major systemic injury
    Minineurologic Examination : reliable minineurologic examination
    prior to sedating or paralying the patient

    Medical Therapies for Head Injury

    Intravenous Fluid:
    1. Keep euvolemic status, dehydration is
    more
    harmful ( vital signs stable )
    2. Not to use hypotonic or glucose-containing fluids
    Hyperventilation:
    1. Keep PaCO2 at 25~30 mmHg when the
    presence of raised
    ICP
    2. PaCO2 < 25 mmHg is avoided ( vasoconstriction ==> CBF
    )

    Medical Therapies for Head Injury


    Mannitol:
    Indication:
    1. Comatous patient who initially has
    normal, reactive
    pupils, but the develops
    pupillary dilatation with or
    without
    hemiparesis
    2. Patient with bilaterally dilated and
    nonreactive
    pupils who are not
    hypotensive
    Dose ( bolus ) : 1 g/Kg
    Lasix : Be used in consultation with a neurosurgeon

    Medical Therapies for Head Injury

    Steroid :
    Not demonstrated any beneficial effect
    Anticonvulsants
    High incidence of Late epilepsy:
    1. Early seizure occurring within the first week
    2. An intracranial hematoma
    3. Depressed skull fracture
    phenytoin reduce the incidence of seizure in the first week of injury
    but not thereafter

    TERIMA KASIH

    22

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