Published on December 17, 2013
Head Injury Mahdi alshehri
Objectives : • • • • • • Definition . Classification . Signs and symptoms . Diagnosis . Management . MV case scenario (head injury) .
Definition : • Head injury refers to trauma of the head. • This may or may not include injury to the brain
Classification : Head injuries may be closed or open : A closed (non-missile) head injury is where the dura mater remains intact .
Cont : • Traumatic brain injury (TBI) : This term refers to a mild brain injury. This injury is a result due to a blow to the head that could make the person’s physical, cognitive, and emotional behaviors irregular. Symptoms may include: Fatigue, Confusion ,Nausea Headaches.
Cont : • Intracranial hemorrhage Types of intracranial hemorrhage are roughly grouped into intra-axial and extra-axial. The hemorrhage is considered a focal brain injury; that is, it occurs in a localized spot rather than causing diffuse damage over a wider area.
• Cerebral contusion : Cerebral contusion is bruising of the brain tissue. The majority of contusions occur in the frontal and temporal lobes. The goal of treatment should be to treat the increased intracranial pressure.
Signs and symptoms • Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurologic deficit. • Common symptoms of head injury include coma, confusion, drowsiness, personality change, seizures, nausea and vomiting, headache.
Causes Common causes of head injury are motor vehicle traffic , home and occupational accidents, falls.
Diagnosis The need for imaging in patients who have suffered a minor head injury is debated. A non-contrast CT of the head should be performed immediately in all those who have suffered a moderate or severe head injury , MRI is also an option.
Management • Most head injuries are of a benign nature and require no treatment beyond analgesics and close monitoring for potential complications such as intracranial bleeding. • neurosurgical evaluation may be useful. • Treatments may involve controlling elevated intracranial pressure.
MV case scenario (head injury)
History : • A 24 years old Saudi male IBW 75 kg admitted to Abqiq general hospital at 26 – 5 – 1433. RTA with a sever head injury and polytrauma. GCS 7/15 , BP: 166/70 , pupils bilateral reactive . Immediately intubated by ETT 7.5 mm at level 22 cm. • Medication : fentanyl 100 ug midazolam 4 mg • Patient on SIMV / PS Vt : 400 ml RR: 12 b/min PS: 10 cmH2O FIO2 :40 %
• Chest X-Ray : Left ribs # 6th . 7th . 8th . • Spinal X-Ray : # C4 ,C5
• second day patient refer to out ICU on portable ventilation Fio2 75% to Dammam medical complex. • CT : bilateral brain contusion bilateral lung contusion • The patient admitted under neurosurgery as care of head trauma .
ABG Result : Ventilator sitting : PH: 7.45 PaCO2: 36 mmgh PaO2: 292 mmgh HCO3:26 FiO2:75% Mode: SIMV + PS VT : 450 ml RR: 12 b/m Spontaneous R : 0 FEEP :5 cmH2O PS:12 cmH2O Flow Trigger : 3 I:E 1:3.2 PIP : 17 cmH2O Decrease FiO2 to 40%
29-5 -33 ABG Result : PH: 7.36 PaCO2: 60 mmgh PaO2: 67 mmgh HCO3:30 FiO2:40% Ventilator sitting : Mode: SIMV + PS VT : 450 ml RR: 18 b/m Spontaneous R : 0 FEEP :5 cmH2O PS:12 cmH2O Flow Trigger : 3 I:E 1:3.2 PIP : 17 cmH2O FiO2 : 60%
1-6-33 ABG Result : PH: 7.46 PaCO2: 44 mmgh PaO2: 117 mmgh HCO3:31 FiO2:50% Ventilator sitting : Mode: SIMV + PS VT : 450 ml RR: 16 b/m Spontaneous R : 0 FEEP :5 cmH2O PS:12 cmH2O Flow Trigger : 3 I:E 1:2.8 PIP : 18 cmH2O FiO2 : 45%
2-6-33 ABG Result : PH: 7.44 PaCO2: 43 mmgh PaO2: 134 mmgh HCO3:29 FiO2:45% Ventilator sitting : Mode: SIMV + PS VT : 450 ml RR: 16 b/m Spontaneous R : 0 FEEP :5 cmH2O PS:12 cmH2O Flow Trigger : 3 I:E 1:2.8 PIP : 17 cmH2O FiO2 : 40%
3-6-33 ABG Result : PH: 7.47 PaCO2: 39 mmgh PaO2: 82 mmgh HCO3:28 FiO2:30% Ventilator sitting : Mode: SIMV + PS VT : 450 ml RR: 16 b/m Spontaneous R : 0 FEEP :5 cmH2O PS:12 cmH2O Flow Trigger : 3 I:E 1:2.8 PIP : 14 cmH2O FiO2 : 30%
8-6-33 The sedative stop for neurological assessment and trial for weaning . • Open eyes spontaneous . • Flex to pain • Slightly movement of right upper limp . right lower limp.
Cont ABG Result : PH: 7.46 PaCO2: 38 mmgh PaO2: 102 mmgh HCO3:28 FiO2:30% Ventilator sitting : Mode: SIMV + PS VT : 450 ml RR: 14 b/m Spontaneous R : 5 FEEP :5 cmH2O PS:12 cmH2O Flow Trigger : 3 I:E 1:3.3 PIP : 14 cmH2O FiO2 : 30%
When sedative hold for weaning the patient become : • Tachypnea • Tachycardia • Feverish For that the weaning trial stop . • After several day patient transfer to OR for a brain surgery .
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