Anesthesia

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HEAD TRAUMA

Tue, 01/01/2008 - 13:38 — oxygen
HEAD TRAUMA Listen to Audio brain1_0.jpg -approximately 50% of deaths involved in trauma result from head trauma -majority of patients with head trauma are young -approximately 10 – 40% of head injures are associated with abdominal injuries +/- long bone fractures Significant head injury associated with: -extent of irreversible neuronal damage at the time of injury -occurrence of secondary insults ex. systemic factors: hypoxemia, hypercapnia, hypotension ex. formation/expansion of hematomas: epidural, subdural, intracerebral ex. sustained intracranial hypertension Glasgow Coma Scale (GCS) generally correlates well with: -severity of injury and resultant outcome ex. GCS ≤ 8 : ≅ 35% mortality Factors on CT imaging associated with increased morbidity in a pt with head trauma: -midline shift greater than 5 mm -lesion larger than 25 ml -ventricular compression Specific lesions which may occur in head trauma include: -skull fractures: (linear, basilar, depressed) -hematomas (epidural, subdural, intracerebral) -brain contusion (coup, contrecoup lesions) -brain concussion -intracerebral hemorrhage -penetrating head injuries -traumatic vascular occlusions -dissections skull fractures generally greatly increase the probability of a significant intracranial lesion linear skull fractures often associated with epidural and subdural hematomas basilar skull fracture may be associated with: CSF rhinorrhea, pneumocephalus, CN palsy, cavernous sinus carotid fistula depressed skull fracture often present with an underlying brain contusion Operative treatment usually involved in: -skull fractures -evacuation of hematomas ( epidural, subdural and intracerebral) -debridement of penetrating injuries ICP monitoring generally indicated for: -significant hematomas -intracerebral hemorrhage -tissue shift ex.patients with ICP > 60 mmHg may be involved with irreversible brain injury Treatment of intracranial hypertension includes: -hyperventilation -mannitol -barbiturates -propofol

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This holds particularly true for athletes in high-contact sports - Football, Soccer, etc.

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