1 / 12

Head Injury

Head Injury. Practical Aspects of Management and Transfer. Susanne Young. CONTENT. Head Injuries Background INITIAL MANAGEMENT Current Guidelines- ATLS Prevention of secondary Brain Injury (1-4) Use of adjunct therapies TRANSFER Which Sedative? AAGBI. BACKGROUND.

vevay
Download Presentation

Head Injury

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Head Injury Practical Aspects of Management and Transfer. Susanne Young

  2. CONTENT • Head Injuries Background • INITIAL MANAGEMENT • Current Guidelines- ATLS • Prevention of secondary Brain Injury (1-4) • Use of adjunct therapies • TRANSFER • Which Sedative? • AAGBI

  3. BACKGROUND • Head injury accounts for approximately 300 per 100 000 hospital admissions per year; of these, 9 per 100 000 die. • RTA's account for about 25% of cases and about 60% of deaths; many die before reaching hospital. • The aim of management is to minimise damage arising from secondary complications.

  4. PROGNOSIS • Traumatic Brain Injury- prognosis at 48HRS GCS <8- severe 9-12- moderate 13-15- mild

  5. INITIAL MANAGEMENT • A-secure a clear airway and control cervical spine • B-treat hypoventilation, severe chest injury • C-control haemorhage and treat shock • D-assess disability • E-exposure, prevent hypothermia *

  6. Principles of management • Prevention of secondary cerebral injury: • 1 Hypoxia • 2 ICP • 3 CPP and CBF • 4 Cerebral metabolism

  7. 1 HYPOXIA • PO2 <10kPa for any reason • If hard collar Consider: • 2 person Manual in-line immobilisation • 3rd person cricoid • Use of McCoy blade • ?Blind Nasotracheal intubation –exc if Basal skull #- if skilled

  8. 2 Control of ICP • Signs of raised ICP (>20mmHg) Papilloedema, BP , HR ,fixed pupils, flaccid, irreg resps (brainstem involvement) • ?Hypoventilate- if in doubt DON’T Moderate hypocapnia CO2 3.5-4 OK Consider if GCS drops suddenly Very low CO2 –vasoconstriction ischaemia

  9. Control of ICP (contd). • Fluid balance- overload can exacerbate cerebral and pulmonary oedema • Sedate initially- Propofol first line Add Midaz if ineffective ? Thio- may cause haemodynamic disturbance • ? Mannitol 0.25-1g/kg (100ml 20%). Buys time only, nephrotoxic- watch uo.

  10. 3 Control of CPP and CBF • CPP= MAP- ICP mmHg • Min CPP 60/70 for adequate perfusion • Cushing reflex designed to restore CPP in presence of ICP therefore • Don’t treat Hypertension! • Mainstay of treatment is to keep SBP>90 • Steroids ineffective (palliative care only)

  11. Control of Cerebral Metabolism • Prevent fits. Prophylaxis in first week. • Phenytoin 15mg/kg loading • Avoid Benzo’s if poss. • ? Active cooling Moderate hypothermia (32-33 for 24hrs) of benefit if GCS at presentation5-7

  12. TRANSFER • INTUBATE AND VENTILATE- but don’t hyperventilate. • SEDATE WITH PROPOFOL • A LINE, CATHETER, ECG etc • Prophylactically- join AAGBI! • become a member of the Group of Anaesthetists in Training (GAT). • Free insurance to cover you during any inter-hospital ambulance transfers !

More Related