Diagnostic Tests and Treatment Plan Flashcards
What are the minimum baseline bloods following head trauma/neuro ? (4)
PCV
TP
Glucose
Electrolytes
Why should you NOT take bloods from jugular with traumatic head injury?
Reduce the risk of increasing the intra-cranial pressure
Has hyper or hypoglycaemia been associated with a high mortality rate?
Hyper
The cushings reflex means WHAT should be monitored on admit following head trauma?
BP
ECG
Due to possible bradycardia and hypertension
After the initial blood testing and monitoring of ECG and BP, what imaging is indicated?
Thorax + abdo (xrays or FAST)
What imaging is described:
Most readily available. Of limited use, but can show skull fractures.
Radiography
What imaging is described:
A shorter acquisition time. Enables a fast evaluation of multiple body cavities.
CT
What imaging is described:
Refined parenchymal detail,especially caudal fossa structures. Least readily available.
MRI
List reasons CT is preferred to MRI with head trauma? (4)
- fast evaluation of multiple cavities
- Shorter acquisition time
- good assessment of skull #
- assess prescence of haemorrhage
On the other hand, MRI provides more refined parenchymal detail especially of which structures?
Caudal fossa
Imaging may enable confirmation of cerebral herniation compatible with raised ICP due to? (3)
haemorrhage, oedema or compression fractures.
Medical therapies with TBI? (9)
O2
IVFT
Mannitol
Analgesia
Anticonvulsants
GI protectant
Nutrition
ABx
Nursing recumbent
What can be performed in comatose/stuporous patients that are intubated can be performed in order to decrease CO2 tension.
Hyperventilation
What does a decrease CO2 tension lead to? (1–>2)
This will lead to direct cerebral vasoconstriction, thereby decreasing cerebral blood volume (CBV) and lowering ICP.
Hyper or Hypo BP leads to high mortality rate?
Hypo
Fluid choice in TBI with hypovolaemia? Why? (2)
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.
How does IVFT have “damage limitations”
Fluid therapy aims to restore intravascular volume to restore adequate cerebral perfusion pressure (CPP)
Mannitol - what is it and why do we use in TBI?
Osmotic diuretic; Raise ICP
Dose of mannitol?
0.5 to 1.5g/Kg can be administered slowly over 20-30 minutes.
Why does mannitol need pre warming?
Crystals may be present in the solution.
What patient should mannitol be given to (fluid volume and organ function)
Normvolaemic
Normal renal
Should prophylactic anticonvulsant be given?
NO - treatment should be instigated immediately if seizure activity is identified
Adverse effects of seizures? (3)
hyperthermia,
hypoxaemia
cerebral oedema
Which drug should NOT be given in TBI
Corticosteroids
