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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??

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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.

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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.

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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..

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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

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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 .

Thank u mam for ur valuable opinion
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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.

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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

Thanks for sharing .

Thank you doctor
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Need B/l decompressive craniotomy duraplasty skullbase repair n cranioplasty

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