Traumatic

Question 1

Basic principle for trauma to the prain

Answer 1

• it is likely to result in local swelling and dysfunction
• the brain is enclosed in a closed space which contains the brain, CSF and blood supply
• therefore, if the brain swells it reduces the space available for CSF and blood
• if the brain becomes ischaemic then it also swells leading to a downward spiral to death

Question 2

Where else is trauma seen alongside brain trauma? Any why?

Answer 2

• shock leads to hypotension which reduces cerebral perfusion
• thoracic trauma may lead to reduced oxygenation of blood which may lead to brain ischaemia exacerbating the problem
• check for other life threatening injuries that need treating (e.g. bladder rupture, pneumothorax, haemorrhage, …)

Question 3

Basic principles of tx

Answer 3

• maintain cerebral perfusion -> treat the shock and maintain arterial blood pressure
• maintain blood oxygenation -> consider oxygen supplementation if appropriate
• monitor neurological status regularly
  – if getting better -> good news
  – if stable -> give it time (brain swelling will take days to reduce)
  – if deteriorating -> bad news -> review if there is anything you can do
• reduce ICP -> mannitol (osmotic diuretic) can be useful short term as a recovery remedy, but need other long term interventions
• think before you use any drugs (e.g. sedation) that may reduce arterial blood pressure and make things worse