Diagnostic Tests and Treatment Plan

Question 1

What are the minimum baseline bloods following head trauma/neuro ? (4)

Answer 1

PCV
TP
Glucose
Electrolytes

Question 2

Why should you NOT take bloods from jugular with traumatic head injury?

Answer 2

Reduce the risk of increasing the intra-cranial pressure

Question 3

Has hyper or hypoglycaemia been associated with a high mortality rate?

Answer 3

Hyper

Question 4

The cushings reflex means WHAT should be monitored on admit following head trauma?

Answer 4

BP
ECG

Due to possible bradycardia and hypertension

Question 5

After the initial blood testing and monitoring of ECG and BP, what imaging is indicated?

Answer 5

Thorax + abdo (xrays or FAST)

Question 6

What imaging is described:
Most readily available. Of limited use, but can show skull fractures.

Answer 6

Radiography

Question 7

What imaging is described:
A shorter acquisition time. Enables a fast evaluation of multiple body cavities.

Answer 7

CT

Question 8

What imaging is described:
Refined parenchymal detail,especially caudal fossa structures. Least readily available.

Answer 8

MRI

Question 9

List reasons CT is preferred to MRI with head trauma? (4)

Answer 9

• fast evaluation of multiple cavities
• Shorter acquisition time
• good assessment of skull #
• assess prescence of haemorrhage

Question 10

On the other hand, MRI provides more refined parenchymal detail especially of which structures?

Answer 10

Caudal fossa

Question 11

Imaging may enable confirmation of cerebral herniation compatible with raised ICP due to? (3)

Answer 11

haemorrhage, oedema or compression fractures.

Question 12

Medical therapies with TBI? (9)

Answer 12

O2
IVFT
Mannitol
Analgesia
Anticonvulsants
GI protectant
Nutrition
ABx
Nursing recumbent

Question 13

What can be performed in comatose/stuporous patients that are intubated can be performed in order to decrease CO2 tension.

Answer 13

Hyperventilation

Question 14

What does a decrease CO2 tension lead to? (1–>2)

Answer 14

This will lead to direct cerebral vasoconstriction, thereby decreasing cerebral blood volume (CBV) and lowering ICP.

Question 15

Hyper or Hypo BP leads to high mortality rate?

Answer 15

Hypo

Question 16

Fluid choice in TBI with hypovolaemia? Why? (2)

Answer 16

Hypertonic saline
- greater capacity for expansion of intravascular volume with a reduced volume of fluids.
- osmotic effect at the interstitial level of the brain parenchyma helping to reduce intracranial pressure.

Question 17

How does IVFT have “damage limitations”

Answer 17

Fluid therapy aims to restore intravascular volume to restore adequate cerebral perfusion pressure (CPP)

Question 18

Mannitol - what is it and why do we use in TBI?

Answer 18

Osmotic diuretic; Raise ICP

Question 19

Dose of mannitol?

Answer 19

0.5 to 1.5g/Kg can be administered slowly over 20-30 minutes.

Question 20

Why does mannitol need pre warming?

Answer 20

Crystals may be present in the solution.

Question 21

What patient should mannitol be given to (fluid volume and organ function)

Answer 21

Normvolaemic

Normal renal

Question 22

Should prophylactic anticonvulsant be given?

Answer 22

NO - treatment should be instigated immediately if seizure activity is identified

Question 23

Adverse effects of seizures? (3)

Answer 23

hyperthermia,
hypoxaemia
cerebral oedema

Question 24

Which drug should NOT be given in TBI

Answer 24

Corticosteroids

Question 25

Why should steroids not be given to TBI? (6)

Answer 25

High mortality:
- Hyperglycaemia
- immuno suppress
- Delayed wound healing
- Gastric ulcer
- Exacerbation of catabolic state

Question 26

TBI - ehy give gastro protectant?

Answer 26

Head trauma has been associated with higher risk of gastric ulceration in humans. In dogs therefore, prophylaxis is recommended.

Question 27

Which feeding tube should NOT be placed with TBI; and why?

Answer 27

aso-oesopahgeal tubes would ideally not be recommended due to facial injuries and risks of sneezing which is detrimental in cases of TBI and suspected raised ICP

Question 28

Why may ABx be used with TBI? What is the choice of ABx?

Answer 28

• Aspiration risk with recumbency
• Wounds

Broad spectrum e..g cephalexin

Question 29

Extra nursing requirements if recumbent? (3)

Answer 29

• Soft bed
• Physio
• Urinary catehter
• Artificial tears

Question 30

What angle should a recumbent patients head be?

Answer 30

15-30o angle. Care should be taken with their positioning to avoid obstruction to jugular venous drainage.

Question 31

Neurosurgery is not commonly performed for the management of the head trauma patient, but it can be considered when?

Answer 31

cases where skull fractures are causing direct compression of the brain parenchyma and contributing to raised ICP

Question 32

What surgical procedures may need to be performed where medical has failed? (3)

Answer 32

Removal of epidural or subdural hematoma, debridement of bite wounds and possible cerebral abscess and/or empyema may be required to reduce intracranial pressure

Question 33

Craniectomy alone will reduce the ICP by?

Answer 33

15%

Question 34

Craniectomy with durotomy will reduce the ICP by?

Answer 34

up to 65%

Question 35

True or false: Prognosis is usually clear at presentation of a head trauma case.

Answer 35

False

Question 36

Prognostic indicators for TBI?

Answer 36

Mental status
Hyperglycaemia

Question 37

What have been described in dogs following traumatic head injury indicating manifest hypothalamic or pituitary damage?

Answer 37

Hypopituitarism (hypothalamic-anterior pituitary hormone deficiencies)