• Head Injury on ITU
    • Pathology
      • Cerebral contusion
        • May swell up to 72 hrs
      • DAI
      • Traumatic SAH
      • Epidural/SDH
    • Pathophysiology
      • Injury leads to accumulation of lactic acid
      • Increased membrane permeability
      • Oedema
      • Increase release of excitatory neurotransmitters
      • Ca²⁺ and Na⁺ influx leads to cell death
      • Cell membrane degeneration leads to apoptosis via caspase activity
    • Avoid secondary brain injury
      • Normotension
        • Single episode of SBP <90mmHg is assd with poor outcome. Keep MAP >70mmHg
      • Normoxia
        • SpO₂ <90% associated with poor outcome
      • Normocapnoea
        • Aggressive hyperventilation may result in further cerebral ischaemia
      • Normothermia
        • Avoid hyperthermia
      • Normoglycaemia
        • Keep 4-8mmol/L
    • Additional monotoring
      • ICP monitor
      • Cranial doppler
      • Jugular bulb oxygen tension
    • Management of raised ICP
      • Medical
        • Ventilate with 100% O₂
        • Ventilate to control CO₂. Hypocarbia useful for short term management only
        • Ensure adequate MAP. Increasing MAP can lead to a decrease in ICP
        • Position check and ensure adequate venous drainage
        • Increase sedation
        • Consider NMBDs
        • Temperature control
        • Osmotherapy
          • Mannitol
          • Hypertonic saline
        • Seizure control
      • Surgical
        • Evacuate haematoma
        • Craniectomy
        • Lobectomy/removal of contusion
        • CSF drainage
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/early/2013/02/24/bjaceaccp.mkt010.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/2/52.full.pdf