HEAD TRAUMA

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-approximately 50% of deaths involved in trauma result from head trauma
-majority of patients with head trauma are young
-approximately 10 – 40% of head injures are associated with abdominal injuries +/- long bone fractures

Significant head injury associated with:
-extent of irreversible neuronal damage at the time of injury
-occurrence of secondary insults
ex. systemic factors: hypoxemia, hypercapnia, hypotension
ex. formation/expansion of hematomas: epidural, subdural, intracerebral ex. sustained intracranial hypertension

Glasgow Coma Scale (GCS)
generally correlates well with:
-severity of injury and resultant outcome
ex. GCS ≤ 8 : ≅ 35% mortality

Factors on CT imaging associated with increased morbidity in a pt with head trauma:
-midline shift greater than 5 mm
-lesion larger than 25 ml
-ventricular compression

Specific lesions which may occur in head trauma include:
-skull fractures: (linear, basilar, depressed)
-hematomas (epidural, subdural, intracerebral)
-brain contusion (coup, contrecoup lesions)
-brain concussion
-intracerebral hemorrhage
-penetrating head injuries
-traumatic vascular occlusions
-dissections

skull fractures generally greatly increase the probability of a significant intracranial lesion
linear skull fractures often associated with epidural and subdural hematomas
basilar skull fracture may be associated with: CSF rhinorrhea, pneumocephalus, CN palsy, cavernous sinus carotid fistula
depressed skull fracture often present with an underlying brain contusion

Operative treatment usually involved in:
-skull fractures
-evacuation of hematomas ( epidural, subdural and intracerebral)
-debridement of penetrating injuries

ICP monitoring generally indicated for:
-significant hematomas
-intracerebral hemorrhage
-tissue shift
ex.patients with ICP > 60 mmHg
may be involved with irreversible brain injury

Treatment of intracranial hypertension includes:
-hyperventilation
-mannitol
-barbiturates
-propofol