TRAUMATIC BRAIN

INJURY
Presenter: Dr Rama Bhupal Reddy
Moderator: Dr Santosh Kumar
A 58 years old male patient presented with a
alleged H/O RTA around 8 pm on 11-4-2022 to
ER. He was hit by a two wheeler.
O/E Patient drowsy and irritable.
PR: 102/min
BP:160/98 MMHG
Temp: 98.6F
Spo2: 96 with room air
RR: 20/min
CVS: S1 and S2 +
RS: Reduced B/L basal AE
 P/A-Soft
 CNS- Drowsy ,
 Patient was intubated and shifted to ICU.

COURSE IN THE HOSPITAL

 12-4-2022 (Day 2): CTBrain plain with cervical

spine and facial bone showed haemorrhagic

contusions with mild perilesional edema in b/l
frontal, posterior parietal temporal lobes and
occipital lobes with mass effect.
 A large parrenchymal hematoma with mild

perilesional edema in right temporal lobe

 Left subdural hemorrhage of max thickness 8.4
mm and right subdural hemorrhage of max
thickness 4mm.
 Focal subarachnoid hemorrhage in right fronto-

parieto-temporal lobes and B/L Occipital lobes.

 CT Abdomen showed displaced fractures of left

8 th to 10 th ribs with adjacent chest wall

hematoma, communited # left acetabulam,mild
left hemothorax.
 Repeat CT Brain showed significant increase in
right temporoparietal contussion with midline
shift.
 He was planned for right FTP Decompressive

craniectomy.
 After induction of anesthesia patient developed

right tension pneumothorax with sudden

desaturation and hypotension. B/L ICD was
placed. Saturation and BP stabilized.
 13-4-2022 (Day 3):

- Post operatively patient was hemodynamically

stable.
-GCS E4VTM6
Blood picture showed thrombocytopenia and
elevated D Dimers
Patient was transfused with 6 SDPS and 4 FFPS.
 At 10 pm patient developed cardiac arrest.

After 1 cycle of CPR pt was reviwed.

 Patient was kept on ventilator .
 Chest Xray was done which showed b/l patchy

opacities in mid and lower lung zones.

 CT Brain : Rebleed into right contussion cavity.
 14-4-2022( Day 4): Tracheal secretions sent

for culture.
 15-4-2022( Day 5): patient developed focal

seizures.
 16-4-2022( Day 6): Tracheostomy was done.
Left ICD was removed.
 18-4-2022( Day 8): patient developed new onset

left hemiparesis and left UMN facial palsy.

 CT Brain showed increase in rebleed in

contussion cavity, IVH and midline shift.

 Re evacuation of right FTP contussion and IVH

with duroplasty was done.

 19-4-2022( Day 9): Patient was

hemodynamically stable on ventilator. GCS

E4VTM6
 25-4-2022( Day 15): Right ICD was removed.
 ET cultures showed XDR Acinetobacter,

antibiotics escalated as per sensitivity.

 Patient tried on T piece gradually, PSV

intermittently. Gradually patient tolerating PSV.

 Hence changed to thermovent and minimal

oxygen support.
2-5-2022 ( Day 22):
Patient discharged to rehabilitation center for
further care. At the time of discharge patient is
normotensive, tolerating thermovent almost 48
hrs and afebrile for last 4 days.
 8-5-2022 ( Day 28):
 Patient developed fever , altered sensorium.
 Patient gradually developed hypotension, so

vasopressors started.
 In v/o deterioration of patient general

condition , Patient shifted to Citizen hospital on

14-5-2022 ( Day 34)with c/o fever, altered
sensorium, hypotension and desaturation.
 O/E
PR: 132/min
BP:64/40 mmhg
RR:32/min
SPO2:97% on 10 lit o2
CVS:S1S2+
RS: Basal crepts+
CNS:E2VTM2