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OF
CRANIOCEREBRAL
TRAUMA
- GCS 5 8
- GCS 3 4
1. Neurosurgical examination
a. General Physical examination
1. 50 60% of GCS <=8 have 1 or more
organ involvement
2. 4 5% spine injury (C1-C3)
3. Hypotension/ anemia
2. Neurologic exam
a. GCS/ Orientation if communicative
b. Cranial nerve II (funduscopy and vision) / III/
eye movement/ VII
c. motor exam- cooperative/ uncooperative,
spine function evaluation if doubtful
d. sensory cooperative/ uncooperative
(central response of grimace/vocalization)
e. reflexes
f. resistance to neck flexion (defer if cervical injury)
3. Laboratory exams
c. Cranial ct scan
- non contrast unless necessary
1. GCS <= 14 (including alcoholic intoxication)
2. GCS 15, for cranial CT scan if:
a. LOC
b. skull fracture
c. neurologic deficit
A. General Measures
3. OSMOTIC THERAPY
a. mannitol- 0.25 1 gm/kbw bolus < 20 min
give q 4- 6 hrs
-may alternate w/ furosemide:
adults: 10 20 mg IV q 6 hrs
pedia: 1mg/kg max 6 mg max IV.
- may alternate with hypertonic saline
b. euvolemia or slight hypervolemia
c. hold osmotic therapy if serum osmolarity
>/= 320 mOsm/L or SBP < 100.
If IC-HTN refractory to A + B:
1. repeat head CT scan to r/o new,
surgical condition
2. EEG to r/o status epilepticus
1. high dose barbiturate therapy: if ICP
remains > 20 25 mmHg
2. hyperventilate to pCO2 = 25 30 mmHg
3. hypothermia: monitored for drop in
cardiac index, thrombocytopenia,
elevated creatinine clearance and
pancreatitis
4. decompressive craniectomy
2. Skull Fractures
c. Hematomas
1. Subarachnoid hemorrhage- most common
cause is severe head injury