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
Why should steroids not be given to TBI? (6)
High mortality:
- Hyperglycaemia
- immuno suppress
- Delayed wound healing
- Gastric ulcer
- Exacerbation of catabolic state
TBI - ehy give gastro protectant?
Head trauma has been associated with higher risk of gastric ulceration in humans. In dogs therefore, prophylaxis is recommended.
Which feeding tube should NOT be placed with TBI; and why?
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
Why may ABx be used with TBI? What is the choice of ABx?
- Aspiration risk with recumbency
- Wounds
Broad spectrum e..g cephalexin
Extra nursing requirements if recumbent? (3)
- Soft bed
- Physio
- Urinary catehter
- Artificial tears
What angle should a recumbent patients head be?
15-30o angle. Care should be taken with their positioning to avoid obstruction to jugular venous drainage.
Neurosurgery is not commonly performed for the management of the head trauma patient, but it can be considered when?
cases where skull fractures are causing direct compression of the brain parenchyma and contributing to raised ICP
What surgical procedures may need to be performed where medical has failed? (3)
Removal of epidural or subdural hematoma, debridement of bite wounds and possible cerebral abscess and/or empyema may be required to reduce intracranial pressure
Craniectomy alone will reduce the ICP by?
15%
Craniectomy with durotomy will reduce the ICP by?
up to 65%
True or false: Prognosis is usually clear at presentation of a head trauma case.
False
Prognostic indicators for TBI?
Mental status
Hyperglycaemia
What have been described in dogs following traumatic head injury indicating manifest hypothalamic or pituitary damage?
Hypopituitarism (hypothalamic-anterior pituitary hormone deficiencies)
