#SimBlog: 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.””
Observations
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:
- Life in the Fast Lane: Increased Intracranial Pressure in Traumatic Brain Injury
Learning Points
Listen to handover fully as important information may come at the end.
Utilise all members of the team and as team leader consider a hands off approach.
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.
Edit & Peer Review by Rebecca Prest
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!
