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.
The GCS is indicative of poor prognosis and no chance of survival. Diffuse axonal injury .Already respiratory and vasomotor centre in medulla are suppressed. Ventilatory support will not help .Better would be attendants take the patient home then spend on ventilator care
Multiple fracture left temporoparietal .SDH rt frontotemporal,thin SDH left,interhemispheric thin SDH ,brain edema with midline shift to left,diffuse punctate hemorrhages suggestive of axonal injury,Sulcal SAH. Major TBI,prognosis poor, supportive care
What abou afordibility if yes just give chance Younge age sad any external injury?? Severe cerebral oedema midline shift impending uncle herniation sdh sah conutercopu injury Ct fluid resuscitation ,check ABG cause of shock acidosis?? SE seum osmolality n urine osmolality, cbc RFT check for dolls eye reflex, EEG neuroSx ref start mannitol n tds 0.1mg/kg,antiepileptic ,decompresive b/l craniectomy will be better, plan trac after Sx, explain poor prognosis ,dvt pump lmwh od dvt after 48 hrs Sx ,if apnea test, dolls eye neg then counseling for organ donation , if You tell them at 1st they thought that u r pulling pt for profit best of luck
Poor prognosis GCS Low Diffuse axonal injury
Diffuse axonal injury, bilateral uncal herniation, durate hemorrhage severe and gross cerebral edema poor prognosis fatal battle..
DAI, Dural hge with gross edema uncal herniation and midline shift, please check brain stem function after adequate decompressive measures, if no brainstorm reflexes then probably no use wasting resources and prepare all for organ donation.
These patients are a potential candidate for organ donation. After appropriate evaluation and counselling this patient can give life to 6 other.
DAI grade 4
Diffuse Axonal injury , poor prognosis
Dai grade 3 with hypoxia brain injury explain relatives very poor prognosis
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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??
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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??
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22yrs old male presented to the emergency department today evening via EMS after being found unresponsive by police near his bike possibility of MVA.Scene to emergency via ambulance 3hrs.Upon arrival patient found to have snoring respirations,moderate pallor,skin condition hot and dry,pulses equal bilaterally in Upper/lower extremities.Patient deteriorated quickly following admission,and was intubated due to low GCS. O/e - Unconscious, decerbrate rigidity positive,B/l plantars upgoing,GCS - E1V1M2,Pupils - B/l 3mm NRTL,Chest - Full of crepts,Abdomen soft,non tender with positive bowel sounds,Nasal bone fracture with nasal bleeding.BP - 140/90mmhg,P/R -67/Mt.Neurosurgeon had seen the case and explained poor prognosis to the patient attendants. INTERPRET CT FINDINGS AND DISCUSS PROGNOSIS??
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29yrs/M unhelmeted motorcyclist,victim of hit and run presented to casualty in unconscious condition on BMV support.Initially intubated and treated at some other hospital then referred to our hospital due to unavailability of Neurosurgeon. O/e - Pupils - Left 8mm NRTL,Right 5mm RTL,GCS - M4E1Vet,BP - 110/90mmhg(On inotropes support),PR - 140/Mt,RR - 32/mt,Abdomen - Soft BS+,Chest -B/l crepts.No bony injury present.DIAGNOSIS AND SUGGEST TREATMENT PLAN??
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27yrs old male involved in a high speed motor vehicle crash.GCS was 3 upon arrival with Bilateral dilated fixed pupil.The neurosurgeon determined that his brain injury is non survivable.KINDLY COMMENTS ON THE CT BRAIN PLEASE??
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