Acute Head Injury

Question 1

Aims of ICU management

Answer 1

Addressing hypotension.
Manage hypercapnia
Address hypertension
Address hypo + hyperglycaemia.
Hyperthermia

Question 2

Intracranial pressure

Answer 2

Normal range: ICP < 15 critical if > 25.

Cushing’s response or Cushing’s triad is a late sign of ICP increase indicating that brainstem herniation is imminent. This is noted by hypertension, bradycardia, altered RR, hight temp

Question 3

Principles of management of TBI

Answer 3

Control intracranial volume and pressure.
Ensure adequate oxygenation and perfusion to the brain
Minimise metabolism to the brain
Improve patient neurological outcomes
Optimise outcomes.

Question 4

Cerebral Perfusion Pressure

Answer 4

Refers to BP gradient across the brain = mean arterial pressure - ICP
Normal value > 70 and critical if < 50

Question 5

Aims of physiotherapy in TBI

Answer 5

Accurate assessment of physiological and functional parameters.
Formulate and implement an appropriate treatment plan.
Monitoring of treatment and adjustment as needed.
Provide emotional support and improve communication.
Liaise with MDT.
Optimise oxygenation to limit secondary brain damage.
Prevent secondary complications.
Initiate reconditioning and early mobility.
Educate family regarding role of physio in acute setting.
Educate family regarding activities they can perform to enhance patient recovery.

Question 6

Contraindications for physiotherapy treatment

Answer 6

CVS instability
Any new ECG abnormalities.
ICP > 25 
CPP < 70
Non reactive dilated pupil.
Temp above 40
Platelets < 30000
Manual chest therapy in case of neurogenic pulmonary oedema.

Question 7

Consideration during physiotherapy treatment in acute phase.

Answer 7

Close monitoring of vital signs.
Bolus of sedation prior to handling 
When patient is turned, keep head in midline.
No direct pressure to bolt , drain or shunt site.
No direct pressure on unprotected brain
Keep Rx sessions short.
Pre-oxygenate prior to and during Rx 
Suction only if needed