65yrs old male victim of RTA leading to head injury on 13/6/18,H/o LOC,vomitting present.K/c/o T2DM since 25yrs,CAD with angioplasty was done back in 2010. Physical examination at the time of admission Conscious but disoriented,Pupils - B/l 5mm reacting to light,GCS - E3V4M6,GCS - P = 13,Bp - 130/80mmhg,PR-60/mt,Spo2-99%.Kindly comment on CT and ECG with proper management plan??

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Left frontotemporal haemorrhagic contusions with inter lobar haemorrhage and SAH. A normal ECG. Significantly raised 16 000 total leukocyte count indicating bacteremia. Cerebral oedema present Treatment- Stop clopidogrel and aspirin which patient must be taking after angioplasty. Start IV fluids. Inj lasix, Inj ceftriaxone 1gm + Sulbactum 500mg B.D for 7days . Inj mannitol infusion 100 ml x 8 hourly Inj Eptoin Inj pantoprazole Oxygen support with mask . Supportive treatment. Atorvastatin 20 mg O. D . NO NEED OF SURGERY . Cardiac monitoring

Traumatic Left Temporal Hemorrhage with contusions with Sub Arachnoid hemorrhage....with surrounding edema and Bradycardia on ECG s/o Increased ICP.... Conservative management required... Hold all anti platelet agents...Measures to decrease ICP...Monitoring

CTshows left FTP multiple contusions and SAH with diffuse cerebral edema Mass effect present as left lateral ventricle compressed. At present conservative measures Cerebral decongestants AED and other supportive measures. However CR needs to be repeated after 24 hrs as the lesions seen in CT can evolve.

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Left T-P SDH with SAH with Right frontal contusion Conservative line of management Close Neuro monitoring Repeat CT after 12 hrs or before if worsens neurologically

SAH with acute left FP subdural with hemorrhagic contusions in bilateral FT cortical region with gross cerebral edema Transverse fracture left mastoid with hemorrhage Effaced interpeduncular cisterns

Small bilateral frontal contusion withSAH

Pt is diabetic .did u write about sugar .in elderly trauma comorbidities can take away the Pt.TLc 16k few hour after admission doesn't necessarily indicate septicaemia but inflammatory response. Coagulation profile should b monitored frequently as platelet already low .

Lt syvian fissure&temporal area lt. Suggest-Active supportive managementwith antiepileptic

Agreed@Dr. Parveen Yograj sir

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