Head Injury & ICP Control

Head Injury & ICP Control

Approx. 30 y/o male, he is a cyclist hit by a car, no helmet worn. En-route his pupil has become fixed and dilated.
— PMH: unknown

PHYSIOLOGY

A – Patent, and groaning

B – Bilateral Air Ent, Sats 98% (100%)

C – HR 110, BP 107/75

D – GCS E1 V2 M2 (5), left pupil fixed and dilated. BM 6.5

E – Temp: 35.9°C

CLINICAL FINDINGS

  • External Head Inj: blood from his nose and a head wound.

  • Abdomen soft

  • No obvious limb injuries


WHY WE SIMULATED

  • Efforts to evaluate and manage increased intracranial pressure (ICP) should begin in the ED.

  • Patients with severe Traumatic Brain Injury (GCS ≤8) and clinical symptoms suggesting possible impending herniation should be treated urgently, with head elevation and osmotic therapy. Features to look for include:

    • Unilaterally or bilaterally fixed and dilated pupil(s),

    • Decorticate or decerebrate posturing,

    • Bradycardia, hypertension, & respiratory depression (Cushing's reflex)

  • These patients may come directly here for stabilisation prior to transfer to the Major Trauma Centre.

Further Reading:

LEARNING POINTS

  1. Listen to handover fully as important information may come at the end.

  2. Utilise all members of the team and as team leader consider a hands off approach.

  3. Mannitol is available in the stacks - with a giving set and instructions on dose, etc.

POSITIVE FEEDBACK

  • Good escalation of voice and tone by anaesthetics when they weren't heard by other team members.

  • Correctly identified the need for neuroprotection.

  • Responded appropriately to patient vomiting

  • Effective communication by nursing staff that they are being allocated too many jobs at one time.

Thank you to the Critical Care team for allowing a trainee and an ODP to join us for a truly multidiciplinary simulation. Hopefully more of these to come!
Edit & Peer Review by Rebecca Prest
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