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| == Background ==
| | #REDIRECT[[Head trauma (main)]] |
| *Classification based on [[GCS]]
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| **14-15: Mild
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| **9-13: Moderate
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| **3-8: Severe
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| *B/l pinpoint pupils suggests opiate use or pontine lesion
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| *Pretreatment w/ lidocaine has not been shown to improve outcomes
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| *All pts on coumadin should have head CT performed
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| == Clinical Decision Rules ==
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| See: [[Head CT in Trauma (Clinical Decision Rules)]]
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| == Diagnosis ==
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| *Monitor for increased ICP
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| **HA, N/V, sz, lethargy, HTN, bradycardia, agonal respirations, posturing
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| *Monitor for herniation
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| **Ipsilateral fixed and dilated pupil
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| **Contralateral motor paralysis
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| ==Differential Diagnosis==
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| {{Intracranial hemorrhage DDX}}
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| ===[[Concussion]]===
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| {{Maxillofacial trauma DDX}}
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| ==Treatment==
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| ===Prevent further brain injury===
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| #Head of bed @ 30 degrees
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| #Prevent:
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| ##Hypotension
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| ##Hypoxia
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| ##Anemia
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| ##Hyperthermia
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| ##Coagulopathy
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| #[[Seizure Prophylaxis in Head Trauma]]
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| ===[[Increased ICP]]===
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| #Ensure adequate sedation (prevent gag reflex)
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| #IVF to goal MAP >80 (maintains cerebral perfusion)
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| #Mannitol
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| ##If SBP>90
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| ###If SBP>90 in adults use hypertonic saline NaCl 5% 150ml over 10 min
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| ##Reduces ICP w/in 30min; duration of action of 6-8hr
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| ##Bolus 20% @ 0.25-1 gm/kg as rapid infusion
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| ##Monitor I+O to maintain euvolemia
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| #Hyperventilation
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| ##No longer recommended as prophylactic intervention
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| ###Hyperventilation to PaCO2 <25 never indicated
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| ##Brief course only recommended if impending herniation (i.e., Cushing reflex)
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| ####Maintain PaCO2 28-35 (20 breaths/min)
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| #Seizure
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| ##Treat immediately
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| ##Seizure prophylaxis reduces sz but does not improve long-term outcomes
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| #Goal CPP ~60mmHg
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| ##If MAP <80, then CPP<60 | |
| ###consider crystalloids or colloids (plasma if INR>1.3)
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| ###phenylephrine 10-100mcg/min, or other pressors prn
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| ###transfuse PRBCs, Hb>7
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| == See Also ==
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| *[[Head Trauma (Main)]]
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| *[[Glasgow Coma Scale (GCS)]]
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| *[[Head trauma (peds)]]
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| == Source ==
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| *Annals 2/09, Stein
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| *Tintinalli
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| [[Category:Trauma]]
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| [[Category:Neuro]]
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