Head Injury part 2

Head Injury part 2

INITIAL EVALUATION AND TREATMENT OF HEAD INJURY:

C. Secondary management:

1.The avoidance of secondary brain injury is essential. Secondary brain injury is produced by hypoxia and hypotension. A single episode of hypotension (systolic blood pressure <90 mmHg) in the adult will worsen prognosis and can increase mortality up to 50%.

2.The GCS obtained in the emergency department may be a more reliable assessment of the severity of brain injury than the GCS obtained in the field.

3.The GCS cannot be assessed by simple observation and requires stimulation of the patient. In cases of asymmetry in either eye opening or motor scores, the best score is used.

4.If time permits, a lateral cervical spine x-ray study usually can be obtained during secondary survey of the patient, which may detect gross injury or malalignment of the cervical spine ). If available rapid C-spine CT should be used to detect fractures as well

D. Indications for ICP monitoring:

*As a general approach, liberal use of ICP monitoring in patients with severe TBI (GCS ≤8) is recommended. An ICP monitor should be used with a brain oxygen monitor. ICP monitoring is not routinely indicated for patients with moderate or mild closed head injury. An ICP monitor should also be considered in a patient with moderate head injury who is going to the OR for other injuries. ICP monitoring is indicated for:

1.Severe closed head injury (GCS ≤8) and abnormal CT of head,,,

a: Definition of abnormal CT:
*Hematoma
*Contusion
*Edema
*Compressed basal cisterns

2.Severe closed head injury (GCS ≤8) and normal CT of head, particularly if two or more of the following exist,,,

a .Age >40 years
b. unilateral or bilateral flexor or extensor posturing
c. Systolic blood pressure <90 mmHg (rapid correction of hypotension is essential)