Concluded Case

EXTRADURAL HAEMORRHAGE HAEMORRHAGIC CONTUSION Č HEMOSINUS Č FACIAL

A 32 years old female is injured by her husband, due to some reason. Her husband is attacked by an axe on her head and face. According to the patient's attendant, her husband's mental status is not good. Chief Complaints At the time of admission Bleeding from nose and lips Swelling at facial and orbital area Vomiting Bleeding Unconsciousness Fever Injured at left cheek and upper lip ( At the time of admission cheek and lip is stitched by vicryl and dressing by seftiloc ) History NAD Vitals One day ago Temp. 102° BP 150/ 100 mmHg Pulse 124bpm Spo2 92% R/R 24bpm But at the present time BP 120/ 70mmHg Pulse 80bpm Spo2 99% without o2 inhalation Temp. 97°F R/R 18 bpm Physical Examination At the present calculator Chest B/L clear Abdo. soft CVS s1 & s2 P UL movement normal LL movement normal No problem in urination and passing of stool Loss of vision in left eye Right eye coordination good Patient is conscious Patient itself complaining facial pain č bodyache She recognizes everything But here is worry about that..... !! 👉 According to neurological studies, in this case or similar, the patient may or may not have received a concussion and may have regained consciousness, but then, as the clot expands over a period of hours, the patient becomes hemiplegic and comatose, some times also seen in some patients are in vegetative stages. Investigations ECG within normal limits sinus rhythm X- ray NAD TC 13900 ESR 80 Hb% 7.9 RBS normal RFT normal LFT normal CT scan shows abnormal findings Awaited for other reports Management Conservative management started PPI Pipzo Mikacin Metrogyl Dexona Cort- s Mannitol Banfo forte Ramcor Chymoral forte Periset o2 accordingly Now the patient's condition is stable. Please suggest respected doctors for further best management. Should neurological surgery be the better for this type of patient......?

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Concluded answer

As Extradural Hematoma is small in size - There, is less,chance of lucid interval period - as you are rightly pointing out - during which haematoma,expands,as middle menigeal artery which is torn in EDH continues to bleed and with increasing EDH -,there is uncal herniation through foramen magnum and patient dies . You have treated the patient very nicely - but there was no need of Amikacin and meteogyl as,Pipzo was enough- because Intracranial haematomas don't get infected , torn dura and open wound . Mannitol was indicated as there are also frontal haemorrhagic contusions and mannitol will prevent rise of Intra- cranial pressure.. But tab Eptoin 300 mg per day or levetiracetam 500 mg O.D should have been started as these patients are prone to seizures and these seizures may further raise the ICP and deterioration in level of consciousness. As of now- just add anti - epileptic drug, stop Amikacin as it is,nephrotoxic and patient is having a very good,prognosis,.But get ENT and Maxilo - facial surgeon 's consultation for the fractures,of maxillary antrum, zygomatic arch , pterygoid plate and orbit . Also - ophthalmologist consultation is indicated Thanks - Dr @Maqusud Ansari

All Answers

As Extradural Hematoma is small in size - There, is less,chance of lucid interval period - as you are rightly pointing out - during which haematoma,expands,as middle menigeal artery which is torn in EDH continues to bleed and with increasing EDH -,there is uncal herniation through foramen magnum and patient dies . You have treated the patient very nicely - but there was no need of Amikacin and meteogyl as,Pipzo was enough- because Intracranial haematomas don't get infected , torn dura and open wound . Mannitol was indicated as there are also frontal haemorrhagic contusions and mannitol will prevent rise of Intra- cranial pressure.. But tab Eptoin 300 mg per day or levetiracetam 500 mg O.D should have been started as these patients are prone to seizures and these seizures may further raise the ICP and deterioration in level of consciousness. As of now- just add anti - epileptic drug, stop Amikacin as it is,nephrotoxic and patient is having a very good,prognosis,.But get ENT and Maxilo - facial surgeon 's consultation for the fractures,of maxillary antrum, zygomatic arch , pterygoid plate and orbit . Also - ophthalmologist consultation is indicated Thanks - Dr @Maqusud Ansari

Valuable opinion
0

Ur on the Right Path of Treatment. Keep on Continuous Monitoring . Neurosurgeon Opinion, ENT,Opthal Opinion and Facimaxillary Surgeon. Repeate CT After 48Hrs

Refer the pt to Neurosurgeon & ENT Surgeon for needful.

Thank you doctor
0

Add inj neurocetam BD and inj epsolin tds

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