Case of the day


6yrs/F child hair's accidentally caught in a spinning roll machine tearing her scalp from right side along with injury to skull presented to emergency department in unconscious condition with GCS 6/15.Intubated and mechanically ventilated due to low NEUROSURGERY REFERENCE WERE DONE FOR SURGERY. Chief Complaints Scalp injury Vitals Vitals wnl Physical Examination Unconscious,moving all four limbs,Plantars B/l extensor. Diagnosis DIAGNOSIS? Management MANAGEMENT PLAN?

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Depressed fracture right temporal bone . No significant intracranial injury except diffuse axonal injury. Prognosis is good in such cases After starting with inj .Eptoin , Parenteral antibiotics, needs an urgent neurosurgical intervention and removal of fractured embedded segment of bone . If not done - serious seizures may occur with further deterioration of GCS Post operatively child needs AED's for at least 3 months

Valuable opinion

surgery for focal depressed #cannot change neurological condition.. patient has diffuse neuronal insult due to impact and hence needs aggressive icu care with astute neuro and intensive care and pediatric supervision

Valuable opinion

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Thank you doctor

Depressed has to be elevated by surgery Any blood collection to be aspirated by Endoscopy Fractured piece of bone should be removed During all the process P T R should be mainted Treatment of complications Post operative care should be done as per senaro of the department

Scan shows #cranium with bone fragment embedded in respective brain parieto occipital lobe Brain oedema is seen Child seems to be critical Neurosurgical intervention is required urgently

Thanx dr Pushkar ji Bhomia

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Depressed fracture skull which require surgical intervention

Fracture rt parietal region Brain oedema Ns drip Intubate Surgical opinion neurosurgeon

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