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Traumatic brain injury (Classification (GCS (Moderate : GCS 9-12,…

- - - - Loss or decrease level of conciousness
      - Loss of memory (retrograde/anterograde amnesia )
      - neurological deficits
      - Alteration in mental status
- - - - Indication to surgery หนามากกว่า 1.5 cm
      - Lucid interval
      - 91% has skull fracture
    - - Bridging vein
      - Indication to surgery *
        
        หนามากกว่า 1 cm
        
        Midline shift ตั้งแต่ 0.5 cm
      - Type
        
        Acute : 0-2 day white
        
        Subacute : 2-14 day gray
        
        Chronic : >14 day black
    - - Trauma or rupture aneurysm
      - Sever headache
    - - Indication to surgery
        
        Blood > 20 ml at frontal or temporal lobe+ midline shift > 0.5 cm.
        
        Blood > 50 ml
      - ใหญ่ขึ้นภายใน1 - 4 วันหลังการบาดเจ็บ
    - - Severe angular and rotational acceleration / deceleration
      - Imaging
        
        Normal CT scan
        
        Seen bleed in MRI at
        
        corpus callosum
        
        hypothalamus
        
        anterior comissure
        
        internal capsule
        
        basal ganglion
        
        brainstem
      - coma more than 6 hours
    - - Suture to prevent hypovolumic shock from massive bleed
    - - Linear
      - Comminuted Depressed
      - Base of skull
        
        cerebrospinal fluid otorrhea halo sign
        
        Hemotypanum
        
        raccoon eyes periorbital ecchymosis
        
        Battle sign postauricular ecchymosis
  - - - Hypotension
      - Hypoxia
      - Hypothemia
    - - Hyperemia
      - Cerebral edema
        
        Vasogenic edema
        
        Brain tumor or brain abcess
        
        Cytokine(VEGF/inflamatory mediator)
        
        Abnormal permeability of BBB
        
        Fluid leakage
        
        Treatment
        
        กำจัด tumor or brain abcess
        
        Steroid ลดการสร้าง cytokine
        
        Cytotoxic edema
        
        cerebral infraction
        
        anoxia
        
        seizure
        
        traumatic brain injury
        
        Impaired Na/K ATPase pump
        
        Increase glutamine
        
        Ca influx
        
        Increase apoptosis
        
        Na influx
        
        Increase edema
        
        Interstitial edema
        
        Increase hydrostatic pressure hydrocephalus
        
        Fluid from ventricle diffuse to periventricular extracellular space
        
        Treatment : VP shunt
    - - ICP > 15 mmHG
      - Cushing’s reflex
        
        Hypertension
        
        Bradycardia
        
        Irregularity of respiratory pattern
      - 1/3 of patient with increase intracranial pressure
      - Treatment
        
        barbiturate coma เพื่อลด cerebral metabolic rate
        
        decompressive craniectomy
        
        mild/moderate hypothermia 32-34 องศา เพื่อลด cerebral metabolic rate และ inflammatory response
        
        osmotherapy: mannitol (0.25-1 g/kg), hypertonic saline
        
        ventriculostomy/ventricular drainage
        
        นอนศีรษะสูง 30 องศา เพืออลด venous outflow resistance
        
        intubation, normocarbic ventilation ป้องกันไม่ให้เกิดภาวะ hypercarbia และ hypoxia
    - - Monroe - Kellie Doctrine
        
        cerebral blood volume
        
        cerebral edema
        
        Mass (intracranial hematoma,tumor)
      - Subfalcine herniation
        
        Midline shift
        
        ACA territory infarction : Severe
      - Uncal herniation
      - Tonsillar herniation
- - - - GCS
        
        13-15
        
        Canadian CT head Rule
        
        15
        
        NEXUS
        
        New Orleans Criteria