16 years old boy victim of RTA today morning 10 am. Presented in emergency with profuse bleeding from multiple lacerated wounds in scalp. GCS E1VTM1. Bilateral pupils dilated and not reacting to light. Doll's eye reflex absent. What should be done? 1. In view of his young age, should go for aggressive craniotomy? 2. Or just explain the prognosis?

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Doll's eye reflex absent is indicative of brain stem injury with poor prognosis. A right frontotemporal SDH with midline shift and diffuse axonal injury . Even aggressive craniotomy will not help. Just explain the prognosis and if patient ' s attendants willing- supportive treatment with ventilatory support

Thank you doctor.
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I do agree with @Dr. Parveen Yograj the brain stem has received some injuries besides the SDH and midline shift , neurosurgeon opinion is a must on this case, prognosis are poor and family should be informed accordingly

Valuable opinion.
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2.Just explain the prognosis.CT rt fronto temporal SDH, rt frontal clntusion, IT parietal contusion , brain edema with mild midline shift.cereballum is becoming white.

Thank you doctor.
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Acute Rt Subdural haematoma with mass effect associated with Diffuse Axonal Injury Prognosis unlikely to survive.Surgery to be taken after excluding Brain Death

Thank you doctor.
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Explain poor prognosis only as pupil fixed dilated and doll’s eye absent.

Thank you doctor.
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Protect vitals+consult Neurosurgeon in view of his age for vigorous tt

Thank you doctor.
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Explain about the prognosis

Thank you doctor.
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Poor prognosis

I agree.
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Is this gcs after resuscitation? Infaction in anterior circulation has set in. Prognosis is very poor. As there is no indication not operating a m1 case, it should be left on relatives with all prognosis explained clearly and taken in writing.

I agree.
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Doll,s eye reflex absent is indicative of brain stem injury with poor prognosis. A right frontotemporal SDH with midline shift and diffuse axonal injury.

Thank you doctor.
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