Scribd Logo
Upload

Welcome to Scribd!

  • Head INjury

    Uploaded by

    cardiacanesthesia
    26 views18 pages
    This document discusses head injuries and recent developments in their management. It notes that head injuries account for 4-5% of trauma deaths annually worldwide, with 20% of cases resulting in neurological sequalae. The document outlines the Glasgow Coma Scale for assessing head injuries and covers pre-hospital and hospital management, including airway control, circulation support, intracranial pressure monitoring, and oxygen monitoring to prevent ischemia. Newer therapeutic approaches discussed include various drugs to reduce inflammation, excitotoxicity and free radicals, as well as stem cell transplantation and gene therapy to improve outcomes.

    Original Description:

    Anesthetic management of Head Injury

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document discusses head injuries and recent developments in their management. It notes that head injuries account for 4-5% of trauma deaths annually worldwide, with 20% of cases resulting in neurological sequalae. The document outlines the Glasgow Coma Scale for assessing head injuries and covers pre-hospital and hospital management, including airway control, circulation support, intracranial pressure monitoring, and oxygen monitoring to prevent ischemia. Newer therapeutic approaches discussed include various drugs to reduce inflammation, excitotoxicity and free radicals, as well as stem cell transplantation and gene therapy to improve outcomes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as ppt, pdf, or txt
    26 views18 pages

    Head INjury

    Uploaded by

    cardiacanesthesia
    This document discusses head injuries and recent developments in their management. It notes that head injuries account for 4-5% of trauma deaths annually worldwide, with 20% of cases resulting in neurological sequalae. The document outlines the Glasgow Coma Scale for assessing head injuries and covers pre-hospital and hospital management, including airway control, circulation support, intracranial pressure monitoring, and oxygen monitoring to prevent ischemia. Newer therapeutic approaches discussed include various drugs to reduce inflammation, excitotoxicity and free radicals, as well as stem cell transplantation and gene therapy to improve outcomes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as ppt, pdf, or txt
    of 18

    HEAD INJURIES

    WHATS NEW
    Dr. P. UPENDER GOWD, MD.,DA
    PROFESSOR & H O D
    DEPARTMENT OF ANEASTHESIOLOGY
    GANDHI MEDICAL COLLEGE
    SECUNDERABAD

    PREAMBLE

    ANNUAL INCIDENCE OF TRAUMA


    26.5 MILLIONS
    TRIMODAL DEATHS
    4-5% - HEAD INJURIES( 1 MILLION )
    27% DEATHS ( <50000 IN USA < 11% )
    20% ARE SERIOUS INJURIES WITH
    NEUROLOGICAL SEQUELE

    HEAD INJURIES
    WHATS NEW

    PRE - HOPITAL MANAGEMENT


    CRITICAL TRANSPORT
    PRIMARY SURVEY
    INITIAL MANAGEMENT
    SECONDARY SURVEY
    DEFINITIVE TREATMENT

    HEAD INJURIES
    WHATS NEW

    GLASGOW COMA SCALE

    EYE OPENING

    VERBAL RESPONSE

    MOTOR RESPONSE

    1,2,3,4
    1,2,3,4,5
    1,2,3,4,5,6

    HEAD INJURIES
    WHATS NEW

    AIRWAY MANAGEMENT

    PREVENTION OF HYPOXIA
    MECHANICAL VENTILATION
    NORMO CARBIA

    HEAD INJURIES
    WHATS NEW

    CIRCULATION

    RESUSCITATION TO NEAR NORMAL BP


    MEAN ARTERIAL PRESSURE 90mm Hg
    CEREBRAL PERFUSION PRESSURE
    INTRACRANIAL PRESSURE

    HEAD INJURIES
    WHATS NEW

    CPP=MAP-ICP
    60 -70 mm Hg

    HEAD INJURIES
    WHATS NEW
    INTRACRANIAL PRESSURE

    (a)
    (b)
    (c)
    (d)

    BRAIN PARENCHYMA
    INTERSTITIAL AREA
    BLOOD VOLUME
    CEREBRO SPINAL FLUID

    HEAD INJURIES
    WHATS NEW

    CEREBRAL METABOLISM

    OXYGEN
    CONSUMPTION
    CEREBRAL BLOOD FLOW
    COMPENSATION AUTO REGULATION
    ISCHAEMIA

    HEAD INJURIES
    WHATS NEW

    ASSESSMENT AND MANAGEMENT

    ASSOCIATED INJURIES 60%


    COMPREHENSIVE TRAUMA LIFE SUPPORT
    (C T L S) GUIDELINES
    PRE-HOSPITAL STABILAZATION
    ENDOTRACHEAL INTUBATION (R S I)
    OXYGENATION (FIO2 SaO2 95%)

    HEAD INJURIES
    WHATS NEW

    PaCO2 32 TO 35 mm Hg
    INTRAVENOUS FLUIDS
    NORMAL SALINE
    HYPERTONIC SALINE 7.5%

    HEAD INJURIES
    WHATS NEW

    MONITORING CEREBRAL
    PERFUSION

    INTRACRANIAL PRESSURE
    ICP < 20 mm Hg
    INVASIVE ICP MONITORING

    PARENCHYMAL
    INTRAVENTRICULAR

    EPIDURAL

    SUBDURAL
    CATHETER

    SUBDU
    RAL
    SCREW

    HEAD INJURIES
    WHATS NEW

    MONITORING OXYGEN
    EXTRACTION

    JUGULAR OXIMETRY 55% - 75%


    <50% SEVERE ISCHEMIA
    >75% PARANCHYMAL INABILITY
    TISSUE OXYGEN PRESSURE by
    POLAROGRAPHIC CATHETER
    NORMAL 15-30 (Lower Value Poor Progno

    HEAD INJURIES
    WHATS NEW

    NEWER THERAPEUTIC MODULES

    ACTIVATION OF IMMUNE MECHANISM


    DRUGS Cyclosporin Mitochon Permeab
    Cannabinoids- Dexanabinol-Excitotoxicity
    Rosuvastatin Post Injury Amnesia
    Melatonin - Free Radical Scavenger
    Progesterone Mod TBI Reduced 57% Deaths

    HEAD INJURIES
    WHATS NEW

    LONG TERM DRUG THERAPY


    Dantrolene /Diazepam Dystonia
    Intrathecal BACLOFEN
    Botulinum Toxin
    Donepezil - Visual & Verbal Memory
    Levodopa

    HEAD INJURIES
    WHATS NEW

    GENE THERAPY( miRNA , siRNA )


    TRANSPLANT NEURAL STEM CELLS
    IMPROVE NEUROGENESIS
    NEUROTROPHIC FACTOR LEVELS
    IMPROVES BEHAVIORAL OUTCOMES

    THANK
    THANK YOU
    YOU

    You might also like