1
Q
Basic principle for trauma to the prain
A
- it is likely to result in local swelling and dysfunction
- the brain is enclosed in a closed space which contains the brain, CSF and blood supply
- therefore, if the brain swells it reduces the space available for CSF and blood
- if the brain becomes ischaemic then it also swells leading to a downward spiral to death
2
Q
Where else is trauma seen alongside brain trauma? Any why?
A
- shock leads to hypotension which reduces cerebral perfusion
- thoracic trauma may lead to reduced oxygenation of blood which may lead to brain ischaemia exacerbating the problem
- check for other life threatening injuries that need treating (e.g. bladder rupture, pneumothorax, haemorrhage, …)
3
Q
Basic principles of tx
A
- maintain cerebral perfusion -> treat the shock and maintain arterial blood pressure
- maintain blood oxygenation -> consider oxygen supplementation if appropriate
- monitor neurological status regularly
– if getting better -> good news
– if stable -> give it time (brain swelling will take days to reduce)
– if deteriorating -> bad news -> review if there is anything you can do - reduce ICP -> mannitol (osmotic diuretic) can be useful short term as a recovery remedy, but need other long term interventions
- think before you use any drugs (e.g. sedation) that may reduce arterial blood pressure and make things worse
