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Head
Trauma
dr. Sri Indah A., Sp.Rad.
ACS
Objectives
ACS
Anatomy and physiology effects?
Ven. Art.
Brain Mass CSF
Vol. Vol.
75 mL Arterial 75 mL
Brain Mass CSF
Volume
ACS
Volume Pressure Curve
60- Herniation
55- ICP
50- (mm Hg)
45-
40-
35- Point of
30- Decompensation
25-
20-
15-
10-
5- Compensation
Volume of Mass
ACS
Intracranial Pressure (ICP)
10 mm Hg = Normal
> 20 mm Hg = Abnormal
> 40 mm Hg = Severe
Many pathologic processes affect outcome
Sustained ICP leads to brain function and
outcome
ACS
Cerebral Perfusion Pressure*
Hypotension 50 20 30
GCS Score = 38
Evaluate and resuscitate
Intubate for airway protection
Focused neurologic exam
Frequent reevaluation
Identify associated injuries
ACS
Classifications of Brain Injury
By Morphology: Brain
Epidural (extradural)
Focal Subdural
Intracerebral
Concussion
Diffuse Multiple contusions
Hypoxic / ischemic injury
ACS
Diffuse Brain Injury
ACS
Contusion / Hematoma
Large frontal
contusion with
shift
ACS
Epidural Hematoma
Uncal
herniation
ACS
Subdural Hematoma
ACS
Priorities
ABCDE
Minimize secondary brain injury
Administer O2
Maintain blood pressure
(systolic > 90 mm Hg)
ACS
Focused Neurologic Exam?
GCS Score
Pupils
Lateralizing signs
ACS
Indications for CT Scan?
ACS