Head trauma (adult) - Revision history

Rossdonaldson1: Redirected page to Head trauma (main)

2015-01-10T19:06:14Z

← Older revision		Revision as of 19:06, 10 January 2015
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	~~== Background ==~~		#REDIRECT[[Head trauma (main)]]
	*Classification based on [[GCS]]
	**14-15: Mild
	**9-13: Moderate
	**3-8: Severe
	*B/l pinpoint pupils suggests opiate use or pontine lesion
	*Pretreatment w/ lidocaine has not been shown to improve outcomes
	*All pts on coumadin should have head CT performed

	~~== Diagnosis ==~~
	*Monitor for increased ICP
	**HA, N/V, sz, lethargy, HTN, bradycardia, agonal respirations, posturing
	*Monitor for herniation
	**Ipsilateral fixed and dilated pupil
	**Contralateral motor paralysis

	~~==Workup==~~
	*Consider brain CT to rule out [[intracranial hemorrhage]]
	**[[Head ~~CT in Trauma (Clinical Decision Rules)]]~~

	~~==Differential Diagnosis==~~
	~~{{Intracranial hemorrhage DDX}}~~

	~~===[[Concussion]]===~~

	~~{{Maxillofacial~~ trauma ~~DDX}}~~

	~~==Treatment==~~
	~~===Prevent further brain injury===~~
	~~#Head of bed @ 30 degrees~~
	~~#Prevent:~~
	~~##Hypotension~~
	~~##Hypoxia~~
	~~##Anemia~~
	~~##Hyperthermia~~
	~~##Coagulopathy~~
	~~#[[Seizure Prophylaxis in Head Trauma]]~~

	~~===[[Increased ICP]]===~~
	~~#Ensure adequate sedation (prevent gag reflex)~~
	~~#IVF to goal MAP >80~~ (~~maintains cerebral perfusion~~)
	~~#Mannitol~~
	~~##If SBP>90~~
	~~###If SBP>90 in adults use hypertonic saline NaCl 5% 150ml over 10 min~~
	~~##Reduces ICP w/in 30min; duration of action of 6-8hr~~
	~~##Bolus 20% @ 0.25-1 gm/kg as rapid infusion~~
	~~##Monitor I+O to maintain euvolemia~~
	~~#Hyperventilation~~
	~~##No longer recommended as prophylactic intervention~~
	~~###Hyperventilation to PaCO2 <25 never indicated~~
	~~##Brief course only recommended if impending herniation (i.e., Cushing reflex)~~
	~~####Maintain PaCO2 28-35 (20 breaths/min)~~
	~~#Seizure~~
	~~##Treat immediately~~
	~~##Seizure prophylaxis reduces sz but does not improve long-term outcomes~~
	~~#Goal CPP ~60mmHg~~
	~~##If MAP <80, then CPP<60~~
	~~###consider crystalloids or colloids (plasma if INR>1.3)~~
	~~###phenylephrine 10-100mcg/min, or other pressors prn~~
	~~###transfuse PRBCs, Hb>7~~

	~~== See Also ==~~
	*[[Head Trauma (Main)]]
	*[[Glasgow Coma Scale (GCS)]]
	*[[Pediatric head trauma]]

	~~== Source ==~~
	*Annals 2/09, Stein
	*Tintinalli

	~~[[Category:Trauma]]~~
	~~[[Category:Neuro~~]]

Rossdonaldson1 at 19:04, 10 January 2015

2015-01-10T19:04:01Z

← Older revision		Revision as of 19:04, 10 January 2015
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	*Pretreatment w/ lidocaine has not been shown to improve outcomes		*Pretreatment w/ lidocaine has not been shown to improve outcomes
	*All pts on coumadin should have head CT performed		*All pts on coumadin should have head CT performed

	~~== Clinical Decision Rules ==~~
	~~See: [[Head CT in Trauma (Clinical Decision Rules)]]~~

	== Diagnosis ==		== Diagnosis ==
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	**Ipsilateral fixed and dilated pupil		**Ipsilateral fixed and dilated pupil
	**Contralateral motor paralysis		**Contralateral motor paralysis

			==Workup==
			*Consider brain CT to rule out [[intracranial hemorrhage]]
			**[[Head CT in Trauma (Clinical Decision Rules)]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* See Also */

2015-01-10T18:59:28Z

Rossdonaldson1: Rossdonaldson1 moved page Head Trauma (Adult) to Head trauma (adult)

2015-01-10T18:58:40Z

Rossdonaldson1 moved page Head Trauma (Adult) to Head trauma (adult)

← Older revision	Revision as of 18:58, 10 January 2015
(No difference)

Rossdonaldson1: /* See Also */

2015-01-10T18:58:25Z

Rossdonaldson1: /* DDx */

2015-01-10T18:57:11Z

DDx

← Older revision		Revision as of 18:57, 10 January 2015
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	**Contralateral motor paralysis		**Contralateral motor paralysis

	== ~~DDx~~ ==		==Differential Diagnosis==
	~~#DAI~~		{{Intracranial hemorrhage DDX}}
	~~#Contusion/[[Intracerebral Hemorrhage]]~~
	#[[~~Epidural Hematoma]]~~		===[[Concussion]]===
	~~#[[Subdural Hematoma~~]]
	~~#Traumatic [[SAH]]~~		{{Maxillofacial trauma DDX}}
	~~#[[Concussion]]~~
	~~#[[Skull Fracture]]~~

	==Treatment==		==Treatment==

Rossdonaldson1: /* Prevent further brain injury */

2014-01-03T06:51:29Z

Prevent further brain injury

← Older revision		Revision as of 06:51, 3 January 2014
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	##Hyperthermia		##Hyperthermia
	##Coagulopathy		##Coagulopathy
	#[[Seizure Prophylaxis (Trauma)]]		#[[Seizure Prophylaxis in Head Trauma]]

	===[[Increased ICP]]===		===[[Increased ICP]]===

Rossdonaldson1 at 06:47, 3 January 2014

2014-01-03T06:47:58Z

← Older revision		Revision as of 06:47, 3 January 2014
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	**Ipsilateral fixed and dilated pupil		**Ipsilateral fixed and dilated pupil
	**Contralateral motor paralysis		**Contralateral motor paralysis
	~~===[[Skull Fracture]]===~~

	~~===Cerebral Contusion / [[Intracerebral Hemorrhage]]===~~
	*Often a/w SAH
	*ICH can occur days after trauma often at site of resolving contusions
	**More common in pts w/ coagulopathy
	~~===[[Subarachnoid Hemorrhage]]===~~

	~~===[[Epidural Hematoma]]===~~

	~~===[[Subdural Hematoma]]===~~

	== DDx ==		== DDx ==
	#DAI		#DAI
	#Contusion/~~intracerebral hematoma~~		#Contusion/[[Intracerebral Hemorrhage]]
	#Epidural		#[[Epidural Hematoma]]
	#Subdural		#[[Subdural Hematoma]]
	#Traumatic [[SAH]]		#Traumatic [[SAH]]
	#[[Concussion]]		#[[Concussion]]
			#[[Skull Fracture]]

	==Treatment==		==Treatment==

Rossdonaldson1: /* Skull Fracture */

2014-01-03T06:43:59Z

Skull Fracture

← Older revision		Revision as of 06:43, 3 January 2014
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	**Contralateral motor paralysis		**Contralateral motor paralysis
	===[[Skull Fracture]]===		===[[Skull Fracture]]===
	*All skull fx require [[Head CT]]
	*ABX indicated for:
	**Open fx
	**Depressed fx
	**Involves sinus
	**Leads to pneumocephalus
	*CTX 2gm IV + metronidazole 500mg +/- Vancomycin 1gm IV

	===Cerebral Contusion / [[Intracerebral Hemorrhage]]===		===Cerebral Contusion / [[Intracerebral Hemorrhage]]===

Rossdonaldson1: /* Subarachnoid Hemorrhage */

2014-01-03T06:42:19Z

Subarachnoid Hemorrhage

← Older revision		Revision as of 06:42, 3 January 2014
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	**More common in pts w/ coagulopathy		**More common in pts w/ coagulopathy
	===[[Subarachnoid Hemorrhage]]===		===[[Subarachnoid Hemorrhage]]===
	*Most common CT abnormality in moderate-severe TBI
	*+Meningeal signs
	*Associated with nonaccidental trauma in infants

	===[[Epidural Hematoma]]===		===[[Epidural Hematoma]]===

← Older revision		Revision as of 18:59, 10 January 2015
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	*[[Head Trauma (Main)]]		*[[Head Trauma (Main)]]
	*[[Glasgow Coma Scale (GCS)]]		*[[Glasgow Coma Scale (GCS)]]
	*[[~~Head~~ trauma ~~(peds)~~]]		*[[Pediatric head trauma]]

	== Source ==		== Source ==

← Older revision		Revision as of 18:58, 10 January 2015
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	== See Also ==		== See Also ==
	*[[Head Trauma (Main)]]		*[[Head Trauma (Main)]]
	*[[Glasgow Coma Scale (GCS)]]		*[[Glasgow Coma Scale (GCS)]]
	*[[~~Concussion]]~~		*[[Head trauma (peds)]]
	*[[Maxillofacial Trauma]]

	== Source ==		== Source ==