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Dr Patrick D Kamalo Neurosurgeon QECH / COM
HEAD INJURY Dr Patrick D Kamalo Neurosurgeon QECH / COM
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OUTLINE Case presentation Epidemiology of head injuries
Classification head injuries Introduction to Mild Head Injuries Definition and Classification of MHI Diagnosis and evaluation Indications for CT scan Indications for admission Evaluation of post-traumatic sequelae
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OUTLINE Case presentation Classification head injuries
Prognostication in Head injury patients Principles of Management
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INDEX CASE 27Y, male Motorcycle accident GCS 15/15, ? Memory loss Facial bruises Observed 3 days Returns with severe headaches Anomia MRI done
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INDEX CASE
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INDEX CASE Lt temporal ICH Blood over tent Subacute SDH
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INDEX CASE MANAGEMENT Bur hole drainage Anti-seizure prophylaxis Aphasia resolved
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Management and outcomes of SHI
INTRODUCTION Head injury epidemiology Classification of HI – multiple schema Anatomical Primary vs secondary injuries Mechanism of injury Morphological CT scan based classification Severity Management and outcomes of SHI
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INTRODUCTION Primary vs Secondary Brain Injury
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Mechanism of Injury
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INTRODUCTION Mechanism of Injury vs Morphology
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CT scan based classification of diffuse brain injury
Category Initial CT findings Diffuse injury I No visible pathology Diffuse injury II Cisterns are present; midline shift <5 mm and/or lesion densities present, no high- or mixed density lesion >25 ml, may include bone fragments and foreign bodies Diffuse injury III Cisterns are compressed or absent; midline (swelling) shift is 0–5 mm; no high- or mixed-density lesion >25 ml Diffuse injury IV Midline shift >5 mm, no high- or mixed-density (shift) lesion >25 ml Evacuated mass Any lesion surgically evacuated Non-evacuated High- or mixed-density lesion >25 ml, not mass surgically evacuated
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INTRODUCTION SHI Mortality, morbidity, survivors Mmmmmmm Mmm mmm
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Factors and interventions influencing outcome before and after traumatic brain injury
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Management of severe head injury in the ICU.
ATLS protocol – cardiopulmonary resuscitation. Stabilise extracranial injuries Evacuate intracranial hematomas Keep the patients head up 30°. Maintain normothermia. Ventilate to a PCO2 of 30–33 mmHg. Insert ICP monitoring device; keep the ICP at <20 mmHg. Keep cerebral perfusion pressure at 60–70 mmHg Pharmacological protection mannitol or hypertonic saline Seizure prophylaxis for 1 week Correct coagulopathy Fluid and electrolyte homeostasis Nutritional support within 72 hrs
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Management of Intracranial Hypertension
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