Please enable JavaScript.
Coggle requires JavaScript to display documents.
Subdural or Extradural Haematoma (NICE Indications for Head CT (Any…
Subdural or Extradural Haematoma
Imaging
Axial Non-Contrast CT Head
Extradural: lentiform opacification
Subdural: sickle-shaped opacification
Extras
Midline shift
Associated cerebral contusion: coup + contra-coup
Associated sub-arachnoid haemorrhage
Colour of haematoma
White (hyperdense): acute
Pale grey (hypodense): chronic (~3wks)
Ask to bony window to accurately assess for skull #
Brain Injury
Primary
Occurs @ time of injury as result of direct injury
Diffuse
Concussion: temporary ↓ in brain function
Diffuse axonal injury
Focal
Contusion
Intracranial haemorrhage
Secondary
Occur after primary injury
Causes
↑ ICP
Infection
Hypoxia or hypercapnoea
Hypotension
Monroe-Kelly Doctrine
Cranium is rigid box so total volume of intracranial contents must remain constant if ICP is not to change.
↑ in volume of one constituent → compensatory ↓ in another:
CSF
Blood (esp. venous)
These mechanisms can compensate for a volume change of ~100ml before ICP ↑.
As autoregulation fails, ICP ↑ rapidly → herniation
Cushing Reflex: imminent herniation
Hypertension
Bradycardia
Irregular breathing
NICE Indications for Head CT
Any amnesia or LOC + 1 of
Dangerous mechanism
over 65yrs
Coagulopathy
Basal or depressed skull #
Amnesia >30min retrograde
Neurology: seizures, focal weakness, blown pupil
GCS: <13 @ scene or <15 2h after trauma
Sickness: persistent vomiting
Digital Subtraction Angiogram
Image
Vessel stenosis
Distal filling by collaterals
Extras
Aortoiliac occlusion → Leriche Syndrome
Types
Acute: ischaemia <14d
Presentation
Pain
Pulseless
Pallor
Cold
Paraesthesia
Paralysis
Incomplete: limb not threatened (e.g. thrombosis)
Complete: limb threatened (e.g. embolism)
Loss of limb unless intervention w/i 6hrs
Irreversible: requires amputation
Mx of Acute Ischaemia
Resus: NBM, hydration, analgesia
UH IVI: prevent thrombus extension
Angiography: only if incomplete occlusion
Surgery
Embolectomy w/ Fogarty catheter
Emergency reconstruction
Complications
Reperfusion injury → compartment syndrome
Chronic pain syndromes
Treat cause
e.g. warfarinise
Mx CV risk
Chronic: stable ischaemia >14d
Critical: ankle pressure <50mmHg + either
Persistent pain requiring opioid analgesia
Ulceration or gangrene
Chronic
Asymptomatic
Intermittent claudication
Rest pain
Ulceration and gangrene
Leriche Syndrome - ED + buttock claudication
Mx of Chronic Ischaemia
Non-surgical
CV risk factor control
Antiplatelet agents
Analgesia
Graded exercise programs: walk through pain
Interventional
Angioplasty ± stenting
Surgical
Reconstruction
Endarterectomy
Amputation
Risk Factors
Modifiable
Smoking
BP
DM control
Hyperlipidaemia
↓ exercise
Non-modifiable
FH and PMH
Male
↑ age
Genetic