8yrs old male child victim of head injury on 22nd of this month in morning,due to the rain a car went into the wrong direction provoked a frontal impact with a tree.Not wearing seat belt.O/e - Unconscious, disoriented with gasping immediately intubated and mechanically ventilated as per ATLS protocol.Pupils - B/l 6mm very slow reactive,GCS - E1V1M3 upon arrival,BP - 160/80mmhg,P/r - 58/mt,Abdomen - soft,non tender with positive bowel sounds,Chest - Full of crepts.Neurosurgeon and paediatrician has seen the case.Poor prognosis explained to attendants. DIAGNOSIS AND MANAGEMENT PLAN??
Bifrontal # with displaced rt frontal bone. Brain is herniating outside through the RT frontal defect.Hehorrhagic contusion both frontal left > rt.. Dr Prasanth you have already correctly done the immediate management& involve the Neurosurgeon & paediatrition. Severe brain edema.Induce hypothermia if possible.Very young brain , usually prognosis at times unpredictable. This child already developed neurogenic pulmonary edema, prognosis seems to be poor.
Bifrontal # with displaced rt frontal bone. Brain is herniating outside through the RT frontal defect.Hehorrhagic contusion both frontal left > rt.. Dr Prasanth you have already correctly done the immediate management& involve the Neurosurgeon & paediatrition. Severe brain edema.Induce hypothermia if possible.Very young brain , usually prognosis at times unpredictable. This child already developed neurogenic pulmonary edema, prognosis seems to be poor.
B/l frontal bone depressed fracture with frontal multiple contusion with sdh,, disappearance of gyrus sulcus.. S/o extreme brain oedema.. B/l crepts suggests aspiration.. Very poor prognosis.. Ad- neuro surgical intervention.. With explained risk.. Proper neuro icu conservative management.. With manitol,, dexamethasone,, broad spectrum antibiotics,, thiopentone infusion..
A large frontal bone fracture right side with fractured chip of bone displaced and frontal brain matter protruding from the fractured defect making prognosis grave with possibility of encephalitis. Also bilateral frontal haemorrhagic contusions . Patient needs to be resuscitated with mechanical ventilation as has been done as per ATSL protocol . Conservative treatment to be continued with IV fluids, parenteral antibiotics, decongestive therapy AED'S; supportive care and neurosurgical opinion
Rt frontal displaced #, severe cerebral edema as no sulci - gyri pattern, midline shift+ , haemorrhagic contusions + . GCS just 4 . Managed properly as per ATLS protocol. Treat for aspiration pneumonia also as chest has lot of creps . Give mannitol & 3% NS for cerebral edema ,also hyperventilate but not to cause hypocarbia . Maintain paco2 > 30. Give fosphenytoin & levatiracitam as anticonvulsants. Prophylactic antacids . Avoid suctioning as it will increase ICP . Do only if necessary . Rest as per neurosurgeon . Yes poor prognosis. But try hard , as in paediatric head injury , some time miracle happens .
Bilateral frontal bone #, with brain tissue protruding out. Gross cerebral odema. Conservative treatment explain prognosis to attendant and take written undertaking regarding risk to avoid future problems.
Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
Agreed to dr. Shilpa. B/L frontal displaced fracture with herniation with contusion with brain oedema. Manitol,hyperventillation , controll seizures with fos phenytoin or levitril drip or thiopentol drip. Neurosurgeon opinion.As herniation is there so carries poor prognosis.explained to relatives and consent.
Frontal plate displaced # .. with ICH and minimal avulsion of brain matter..HIGH risk poor prognostic patient
Need B/l decompressive craniotomy duraplasty skullbase repair n cranioplasty
Cases that would interest you
- Login to View the image
Day 25/ M p/w gasping breathing with h/o fever, cough and cold for 5 days and difficulty in breathing for 2 days and abnormal movement one episode today, was intubated .CXR s/o haziness in left lung.CSF study protein 140.6 , sugar 50/122 , no cells. CRP 22.8 mg/L. TLC 25400. sodium 135 , potassium 4.6. USG shull normal. Please comment on CNS infection , diagnosis and mgt. ???
Dr. Raquib Parwez1 Like12 Answers - Login to View the image
NEW CASE -30yrs old male presents by EMS post MVC.According to EMS,The Patient drove off the road into a grove of trees.Intubated and mechanically ventilated upon arrival to emergency due low GCS and agonal respiration. O/e - Unconscious,extensor posturing of all extremities.Gasping,Pupils - B/l 6mm NRTL,GCS - E1M3V1,Chest - Aspirated,Abdomen - Soft,Non tender,BP - 140/90mmhg,PR - 72/Mt,RR - 32/Mt,Temp - 102°F on presentation.Antipyretics and cooling wraps were initiated to control the fever,His fevers persisted with marked fluctuations despite antibiotic therapy. Lab values -Hb - 14, TLC - 28,000,Na - 150,K -2.2,LFT-Normal,Raised urine output. Present status - Unconscious on ventilator support,Pupils - Right 6mm NRTL,Left - 4mm SRTL,Temp - 102°F.NEURSURGEON EXPLAINED PROGNOSIS TO RELATIVES. DIAGNOSIS AND APPROACH PLEASE??
Dr. Prashant Ved0 Like12 Answers - Login to View the image
*Chief Complaint* 69 year old female presented with the complaint of abdominal pain, vomiting, fever, malaise, shivering, and a feeling of unease after colonoscopy. *Vitals* BP: 110/80 mmhg, Resp rate:14 breaths per minute, Pulse: 69 bpm, Temp: 97.6 degree C, saturation was ~80% with nasal cannula. *Examination* She looks little pale on examination. *Investigations* The initial chest radiograph was done which shows patchy alveolar infiltrates in the left lung. What else do you see? *Treatment* How should we manage?
Dr. Narendra Kumar0 Like10 Answers - Login to View the image
A 20 yrs Post Lucs Pt admitted to ccu c/o convulsions with High BP 170/90 O/E pts drowsy P 104,SpO2 99%,RBC 5×10^6,WBC 19800 N 86 Hb 13.8,Plc 1.45 L Ur 20,Cr 0.9 Chol 385,HDL 43,LDL 248 Tgl 556 Uric acid 12.1, Bil 0.64 , T.protien 8.1 , Alb 3.8 SGOT 697, SGPT 375 , Alk. phos 1014 Please Suggest Treatment
Dr. Mahananda Mistri1 Like5 Answers - Login to View the image
Patient came to hospital to have surgery for bladder stone...underwent cystolithotripsy with TRUS... Next day developed AF and x ray shows this.... TLC- 14000... Creatinine -2.70.... Patient now on mechanical ventilation., ionotropic support, antibiotics( teicoplanin, levofloxacin) What to do next???
Dr. Varinder Pal Singh2 Likes19 Answers
4 Likes