Head trauma (main): Difference between revisions

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*[[Pediatric head trauma]]
== Background ==
== Background ==
*Classification based on [[GCS]]  
*Classification based on [[GCS]]  
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==Management==
==Management==
*Pretreatment w/ lidocaine has not been shown to improve outcomes  
*Pretreatment w/ lidocaine has not been shown to improve outcomes  
*[[Seizure Prophylaxis in Head Trauma]]
*[[Management of Elevated Intracranial Pressure]]


==See Also==
==See Also==
*[[Seizure Prophylaxis in Head Trauma]]
*[[Management of Elevated Intracranial Pressure]]
*[[Glasgow Coma Scale (GCS)]]
*[[GCS (Peds)]]
*[[Pediatric head trauma]]
*[[Pediatric head trauma]]


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[[Category:Trauma]]
[[Category:Trauma]]
[[Category:Neuro]]
[[Category:Neuro]]
==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

Revision as of 19:19, 10 January 2015

Background

  • Classification based on GCS
    • 14-15: Mild
    • 9-13: Moderate
    • 3-8: Severe

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
  • B/l pinpoint pupils suggests opiate use or pontine lesion

Workup

Differential Diagnosis

Intracranial Hemorrhage Types

Concussion

Maxillofacial Trauma

Management

See Also

Source