Head Injury Management

DIFFUSE BRAIN DAMAGE/NEGATIVE CT SCAN

A proportion of patients have no intracranial haematoma on CT scan or have only a small haematoma or contusion causing no mass effect.

In these patients, coma or impairment of conscious level may be due to: - diffuse axonal injury - suspect if no improvement in conscious level from impact.

- cerebral ischaemic damage

- cerebral swelling -fat emboli

- meningitis suspect if deterioration is delayed - a patient who talks after impact does not have a significant shearing injury.

Several of these factors may coexist and contribute to brain damage in patients with intracranial haematoma.

The management principles outlined above apply; in particular it is essential to ensure that respiratory function is adequate and that cerebral perfusion pressure is maintained.

Fat emboli usually occur a few days after injury and may be related to fracture manipulation; deterioration of respiratory function usually accompanies cerebral damage and most patients require ventilation.

Meningitis may occur several days after injury in the presence of basal fractures.

Cerebral swelling may occur at any time after injury and cause a rise in intracranial pressure.

REPEAT CT SCANNING

Indications:

Delayed deterioration in clinical state Maintained rise in I CP

Failure to improve after 48 hours

Occasionally, small areas of 'insignificant' into a space-occupying haematoma requiring recollection may occur in 5-10% of cases.

in patients with diffuse injury or following evacuation of an intracranial haematoma contusion on an initial CT scan may develop ; evacuation. Following haematoma evacuation,

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