Synonyms and related terms:
Head trauma a.k.a. head injury a.k.a. traumatic brain injury TBI
Diagnosis:
Clinical
With or without neuroimaging: CT more commonly than MRI,
Classification, the Glasgow coma scale GCS was designed for this:
Mild: GCS 13-15
Moderate: GCS 9-12
Severe: GCS = or <8
Critical: GCS 3-4
Treatment:
If mild:
- Consider discharge or observation
ABCD drill (Airway, Breathing, Circulation, Deficits)
Treat surgically correctible lesions
If not mild, consider prophylactic antiepileptic drugs:
- Phenytoin PHT or levetiracetam, only for 1 week
- If open skull fracture or Gun shot wound, consider 3 months prophylaxis
In severe trauma:
- ICP monitoring if abnormal CT or high risk
- Keep cerebral perfusion pressure CPP >50 mmHg, but avoid >70 mmHg by:
- Cerebral perfusion pressure CPP= mean arterial pressure MAP – intracranial pressure ICP
- Noradrenaline I.V. infusion
- Fluids: Saline. Avoid albumin. [SAFE]
- Corticosteroids should not be used routinely