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Additional resources for Acute Surgical Management
7) Maintaining core temperature between 36 and 37°C. (8) No seizures. Indications for intubation4 Head injured patients with any of the following should be intubated: (1) (2) (3) (4) (5) (6) Severe facial fractures. A GCS between 3 and 8. Arterial oxygen partial pressures less than 60 mmHg. Systolic blood pressure less than 90 mmHg. Signs of transtentorial herniation (see below). Suspicion of neurological deterioration not due to extra-cranial explanations. Acute Management of Head Injuries 17 Indications for mannitol1 Mannitol is a high-molecular-weight sugar that can be administered to lower the ICP.
3 Left cerebellar ICH (greater than 3 cm diameter). Intra-cerebral Haemorrhage in Adults 31 herniation (coning). On the cellular level experimental studies have shown decreased local cerebral blood flow, hyperaemia, dysautoregulation, and blood-brain barrier disruption in the brain surrounding haematomas. These events are thought to initiate a cascade of biochemical processes that precipitate cellular metabolic disruption and eventual cell death. The biochemical cascades are thought to be similar to what happens in cerebral ischaemia.
1). In cases where there has been repeated injury, the CT scan can show chronic subdural collections and cerebral atrophy (Fig. 2). These children sometimes present in extremis, with deep coma or status epilepticus. Resuscitation is required, followed by urgent neurosurgical intervention. Despite this, the outcome is usually poor, with high mortality rates. In infants and toddlers (age less than two years), linear fractures and cephalohaematomas are common, even with seemingly minor trauma. “Ping-pong” fractures are depressed fractures which occur because of the relatively thin cranial vault.