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A case of Head injury

New Case 31 yr ,M, Found unconcious on the road with his motor cycle lying over him around 11 PM on 16th of this month.Taken to Govt Medical College and then transfered to 2nd Govt Medical college where he was intubated due to low GCS .The relatives brought him in our hospital for further management. On exam intubated on AMBU,GCS E1 Vt M1.Pupil Rt dialated and fixed ,left 2 mm non-reacting.Bp 110/ 70 mmhg,HR48/ mt. Diagnosis and management.

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Thanks for all answeres. CT brain: * Acute EDH Rt frontotempiroparietal with underlying Rt tempiroparietal bone fracture. * Midline shift to left. * Uncal herniation to left. * SAH along the bilateral sylvian fussure,interhemisphric fissure,left temporal cortical sulci. * Multiple intraparenchymal contusion in the left frontotemporoparietal region and Rt temporal region. * Small SDH along the lt temporal region. Emergency craniectomy with evacuation of hematoma done after discussing with the seriousness of illness and multople lesions. Tracheostomy done .patient is improving.

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Thanks for all answeres. CT brain: * Acute EDH Rt frontotempiroparietal with underlying Rt tempiroparietal bone fracture. * Midline shift to left. * Uncal herniation to left. * SAH along the bilateral sylvian fussure,interhemisphric fissure,left temporal cortical sulci. * Multiple intraparenchymal contusion in the left frontotemporoparietal region and Rt temporal region. * Small SDH along the lt temporal region. Emergency craniectomy with evacuation of hematoma done after discussing with the seriousness of illness and multople lesions. Tracheostomy done .patient is improving.

Right FTP EDH and left parietal bone fracture with midline shift and mass effect with herniation right side. Check for respiratory triggers and dolls eye. If any vital signs are present then can go for craniotomy and evacuation of haematoma as patient is young.

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Huge edh with midline shift.under icu.care Antiedmameasures the only hope is immediate evacuation of EDH. by craniotomy.contour coup injry of brain on the opposite site noticed. It will be taken care by antiedema measures

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Fracture with extradural heamorrhag and mid line shift and hemorrhagic contusions and subarachnoid hemmorhages

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The Glasgow Coma Scale was originally developed to help determine the severity of a coma or dysfunction following a traumatic brain injury, but can be useful for any condition leading to impaired consciousness. Today, it is consistently used for many conditions including stroke (subarachnoid haemorrhage, intracerebral haemorrhage, or ischemic stroke), infection, seizures, brain abscess, general traumas, non-traumatic coma, overdose and poisoning It can also be administered in a variety of settings such as pre-hospital, arrival at the emergency department and in the hours following admission, giving it the ability to monitor changes and trends in patient consciousness over time.  Modified scales have been developed for use in other populations. The Glasgow Coma Scale - Extended (GCS - E) includes the use of an amnesia scale in order to avoid the premature discharge of patients with mild traumatic brain injury. The motor scale has proved the most useful for assessment in when studying blunt trauma.Research has indicated that using the motor scale alone can simplify the assessment process while maintaining the accuracy of the score

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What treatments are available? Mild TBI usually requires rest and medication to relieve headache. Moderate to severe TBI require intensive care in a hospital. Bleeding and swelling in the brain can become an emergency that requires surgery. However, there are times when a patient does not require surgery and can be safely monitored by nurses and physicians in the neuroscience intensive care unit (NSICU). The goals of treatment are to resuscitate and support the critically ill patient, minimize secondary brain injury and complications, and facilitate the patient's transition to a recovery environment. Despite significant research, doctors only have measures to control brain swelling, but do not have a way to eliminate swelling from occurring.

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Medication Sedation and pain. After a head injury it may be necessary to keep the patient sedated with medications. These medications can be turned off quickly in order to awaken the patient and check their mental status. Because patients often have other injuries, pain medication is given to keep them comfortable. Controlling intracranial pressure. Hypertonic saline is a medication used to control pressure within the brain. It works by drawing the extra water out of the brain cells into the blood vessels and allowing the kidneys to filter it out of the blood. Preventing seizures. Patients who've had a moderate to severe traumatic brain injury are at higher risk of having seizures during the first week after their injury. Patients are given an anti-seizure medication (levetiracetam or phenytoin) to prevent seizures from occurring. Preventing infection. Although every attempt is made to prevent infection, the risk is always present. Any device placed within the patient has the potential to introduce a microbe. If an infection is suspected, a test will be sent to a laboratory for analysis. If an infection is present, it will be treated with antibiotics.

Neurocritical care Neurocritical care is the intensive care of patients who have suffered a life-threatening brain injury. Many�patients with severe TBI are comatose or paralyzed; they also�may�have suffered injuries in other parts of the body. Their care is overseen by a neurointensivist, a specialty-trained physician who coordinates the patient's complex neurological and medical care. Patients are monitored and awakened every hour for nursing assessments of their mental status or brain function.

Surgery Surgery is sometimes necessary to repair skull fractures, repair bleeding vessels, or remove large blood clots (hematomas). It is also performed to relieve extremely high intracranial pressure.

Classical rt frontotemporal EDH Urgent surgical evacuation

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