TRAUMA LIFE SUPPORT

HEAD
TRAUMA

QUEEN TRAUMA LIFE SUPPORT 2018

TRAUMA LIFE SUPPORT Chapter Statement

The primary goal of treatment for patients with

suspected traumatic brain injury is to prevent
secondary brain injury.
TRAUMA LIFE SUPPORT Objectives

1. Describe basic intracranial anatomy and physiology

2. Explain the role of adequate resuscitation in limiting secondary
brain injury
3. Identify the considerations for patient transfer, admission, and
discharge of patients with head injuries.
TRAUMA LIFE SUPPORT Anatomy review
TRAUMA LIFE SUPPORT Physiology review
Monroe-Kellie Doctrine
TRAUMA LIFE SUPPORT Physiology review

CPP = MAP – ICP

CPP – cerebral perfusion pressure
MAP – mean arterial pressure
ICP – intracranial pressure

Cerebral blood flow ≠ CPP

Normal ICP 10mmHg
 Classification of Head
Injuries
TRAUMA LIFE SUPPORT
TRAUMA LIFE SUPPORT Epidural hematoma

• Biconvex or lenticular in shape

• Most often located in the temporal or
temporoparietal region
• Result from tear of the middle meningeal artery
due to skull fracture
• Classic presentation – ‘lucid interval’
TRAUMA LIFE SUPPORT Subdural hematoma

• Developed from shearing of bridging veins

• Appear to conform to brain contours
• Presence of concomitant brain parenchymal
injury
 Contusions and Intracerebral
hematoma
TRAUMA LIFE SUPPORT

• Mostly in the frontal and temporal lobes

• CT changes usually progressive and

requires repeat CT scanning within 24
hours of the initial scan
(contusions  intracerebral hematoma)
TRAUMA LIFE SUPPORT Evidence-based Treatment Guidelin

(i) Mild brain injury

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(ii) Moderate brain injury
TRAUMA LIFE SUPPORT (iii) Severe brain injury
TRAUMA LIFE SUPPORT Goals of treatment of brain injury
TRAUMA LIFE SUPPORT Medical therapies for brain in
(i) Intravenous fluids
- to maintain normovolemia using Normal saline or Ringer’s
lactate
(ii) Hyperventilation
- use ONLY in moderation and for as limited a period as possible
(keep PCO2 ~ 35mmHg)
(iii) Mannitol
- osmotic diuresis; to reduce elevated ICP
- dose 0.25 - 1g/kg Mannitol 20%
TRAUMA LIFE SUPPORT
Medical therapies for brain injury
(iv) Hypertonic saline
- lowers ICP; preferable agent for patients with hypotension

(v) Barbiturates
- effective in reducing ICP refractory to other measure; causes
hypotension

(vi) Anticonvulsant
- use to control acute seizures; does not change long term seizure outcome
and can inhibit brain recovery
- Phenytoin loading dose 1g IV given no faster than 50mg/min followed by
maintenance dose 100mg/8 hours
TRAUMA LIFE SUPPORT Surgical management

(i) Scalp wounds

- may cause extensive blood loss
- control scalp hemorrhage by applying direct pressure and
cauterizing or ligating large vessels; then apply sutures

(ii) Intracranial mass lesions

- immediate neurosurgical consult
- emergency craniotomy
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Surgical management

(iii) Penetrating brain injuries

- CT scan
- Early neurosurgical consult
- Prophylactic broad spectrum antibiotics
- DO NOT remove penetrating object
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Brain Death
• Diagnosis requires,
- GCS = 3
- Nonreactive pupils
- Absent brainstem reflexes
- No spontaneous ventilator effort on formal apnea testing
- Absence of confounding factors such as alcohol or drug intoxication or
hypothermia
• Confirmatory studies include,
- EEG : No activity at high gain
- CBF studies : No CBF
- Cerebral angiography
Thank You