20yrs old male driving a car involved in a highway MVC with Truck on .Patient groaning at scene.Scene to ED transport via ambulance about half n hour.Intubated and mechanically ventilated uppon arrival to emergency following ATLS. O/e - Pupils - Left 6mm NRTL,Right 4mm SRTL,GCS - E1V1M3-4.How to proceed with this case??
CT shows bilateral basifrontal contusions, a contusion in midbrain with cerebral edema and multiple craniofacial fractures Pt probably has DAI too. No surgically evacuable lesion in Conservative management as per trauma protocol of TBI
Bifrontal contusion, small interhemispheric blood, # nasal bones, brain edema bilaterally Air bubbles in the orbital, nasal& soft tissue. Suggest active supportive management as per trauma protocol. No neurosurgical intervention.at present .Consultation ENT , ophthalmology
Contusions seen in bifrontal area and brain stem # frontal bone Diffuse cerebral edema Multiple facial bones # Conservative line of management as of now Consultations needed: Neurosurgery and Faciomaxillary
Agreed with sanjay sir ...recent trauma guideline 2017 ...managment of severe traumatic brain injury ..include 1.treatment 2 monitoring cerebral perfusion ..icp monitoring ...maintain blood pressure ...cvp monitoring.. ...icp threshhold etc ... repeat scan to be done to rule out ... aggravating cerebral edema or post traumatic infarct..
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Bifrontal contusion RT>>Lt ... With interhemispheric haemorrhage with DAI. patient needs to be managed conservatively at the moment. Start Mannitol, Antiepileptics and repeat CT. and follow.....
Thank to all experts.
Check BP HR O2 Saturation IV fluids matched packed cell transfusion CT Brain plain 1hrly vitals Monitoring.
Le fort fracture requiring wiring.Nasal bone which is impact require deimpactio with Acsep forceps either immediate/intacranial edema subsides.Late repair may be difficult
CT Brain plain Antiepileptics Neurophysiology consultation
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A 26yrs old male presented to casualty as a case of RTA leading to head injury.Initially patient was treated somewhere else and on ET tube we put him on venti support.primary survey and secondary survey done according to ATLS protocol. O/e - CNS - Deeply unconscious pupils - Dilated fixed GCS - E1 VTM1 BP - 100/70mmhg on inotropes Pr - 130/mt Poor prognosis explained to attendant.
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young female child 15yrs old,brought to casualty comatosed(fall from bike due to slip today 3.45pm).Responds only to pain having supraorbital oedema.Patient is emergently intubated and mechanically ventilated due to low GCS. O/e Deeply unconscious,Pupils - B/l 7mm NRTL GCS - 4/15 Patient is now on cerebral decongestant,AEDs,PPI and IV saline infusion. Patient having tachycardia 130 with hight blood pressure mainly diastolic pressure,140/110.Poor prognosis explained CT enclosed.
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