Stem: A 24-year-old young male brought to ED after RTA. On arrival, he had GCS 15, & then he vomited twice & after 20 minutes he become unconscious; now GCS decreased to 8. You have been called to see this patient. Considering this as critical care station, answer the following questions.
- How will you manage this patient?
— I will follow the A, B, C, D protocol
- What will you expect in the CT scan?
— biconvex, midline shift, & compression on the ventricle.
- What is the normal ICP?
— Its 7-15 mm Hg( supine) &
- How will measure ICP? (Different methods?)
-Intraventricular catheter (EVD- external ventricular drain)
-Lumbar CSF pressure
-Tympanic membrane displacement
- What body parts are injured?
- What is GCS & what are its constituents?
- Single test to confirm diagnosis? – CT head
- When will you consider CT brain for trauma?
—High Risk Criteria:
– GCS < 15 at 2 hours post-injury.
– Suspected open or depressed skull fracture.
– Any sign of basilar skull fracture:
– ≥ 2 episodes of vomiting.
– Age ≥ 65.
– Any head injury in anticoagulated patient.
—Medium Risk Criteria:
– Retrograde Amnesia to the event ≥ 30 minutes.
– “Dangerous” Mechanism:
-Pedestrian struck by motor vehicle.
-Occupant ejected from motor vehicle.
-Fall from > 3 feet or > 5 stairs.
- NICE guidelines: Criteria for performing a CT head scan. :
—For adults who have sustained a head injury & have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:
–GCS < 13 on initial assessment in the emergency department.
–GCS < 15 at 2 hours after the injury on assessment in the emergency department.
–Suspected open/depressed skull fracture.
–Any sign of basal skull fracture (hemotympanum, ‘panda’ eyes, CSF leakage from the ear or nose, Battle’s sign).
–Focal neurological deficit.
–More than 1 episode of vomiting.
A provisional written radiology report should be made available within 1 hour of the scan being performed.
- Describe CT head. – lenticular/ biconvex lesion—extradural haematoma.
- Management of raised ICP?
- GCS drops – management?
- Cause of secondary GCS drop?