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Neurosurgical Consultation For Patients With TBI

1) Head injuries are among the most common types of trauma encountered in emergency departments. Severe brain injuries often lead to death before reaching the hospital. 2) Over 1.7 million traumatic brain injuries occur annually in the US, including 275,000 hospitalizations and 52,000 deaths. Many survivors are left with long-term disabilities. 3) Proper treatment of head trauma aims to prevent secondary brain injury by ensuring adequate oxygen and maintaining safe blood pressure levels to perfuse the brain. Patients may require transfer to facilities that can perform neurosurgery or provide higher levels of care.

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Nawaid Khan
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86 views1 page

Neurosurgical Consultation For Patients With TBI

1) Head injuries are among the most common types of trauma encountered in emergency departments. Severe brain injuries often lead to death before reaching the hospital. 2) Over 1.7 million traumatic brain injuries occur annually in the US, including 275,000 hospitalizations and 52,000 deaths. Many survivors are left with long-term disabilities. 3) Proper treatment of head trauma aims to prevent secondary brain injury by ensuring adequate oxygen and maintaining safe blood pressure levels to perfuse the brain. Patients may require transfer to facilities that can perform neurosurgery or provide higher levels of care.

Uploaded by

Nawaid Khan
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CHAPTER 6 n Head Trauma

H
ead injuries are among the most common within a particular community. For facilities without
types of trauma encountered in emergency neurosurgical coverage, ensure that pre-arranged
departments (EDs). Many patients with severe transfer agreements with higher-level care facilities
brain injuries die before reaching a hospital; in fact, are in place. Consult with a neurosurgeon early in the
nearly 90% of prehospital trauma-related deaths course of treatment. n BOX 6-1 lists key information
involve brain injury. Approximately 75% of patients to communicate when consulting a neurosurgeon
with brain injuries who receive medical attention can about a patient with TBI.
be categorized as having mild injuries, 15% as moderate,
and 10% as severe. Most recent United States data
estimate 1,700,000 traumatic brain injuries (TBIs) A n atom y R e v ie w
occur annually, including 275,000 hospitalizations
and 52,000 deaths.
TBI survivors are often left with neuropsychological A review of cranial anatomy includes the scalp, skull,
impairments that result in disabilities affecting work meninges, brain, ventricular system, and intracranial
and social activity. Every year, an estimated 80,000 to compartments (n FIGURE 6-1).
90,000 people in the United States experience long-term
disability from brain injury. In one average European
country (Denmark), approximately 300 individuals Scalp
per million inhabitants suffer moderate to severe head
injuries annually, and more than one-third of these Because of the scalp’s generous blood supply, scalp
individuals require brain injury rehabilitation. Given lacerations can result in major blood loss, hemor-
these statistics, it is clear that even a small reduction rhagic shock, and even death. Patients who are
in the mortality and morbidity resulting from brain subject to long transport times are at particular risk
injury can have a major impact on public health. for these complications.
The primary goal of treatment for patients with
suspected TBI is to prevent secondary brain injury. The
most important ways to limit secondary brain damage Skull
and thereby improve a patient’s outcome are to ensure
adequate oxygenation and maintain blood pressure The base of the skull is irregular, and its surface can
at a level that is sufficient to perfuse the brain. After contribute to injury as the brain moves within the
managing the ABCDEs, patients who are determined skull during the acceleration and deceleration that
by clinical examination to have head trauma and occurs during the traumatic event. The anterior fossa
require care at a trauma center should be transferred houses the frontal lobes, the middle fossa houses the
without delay. If neurosurgical capabilities exist, it temporal lobes, and the posterior fossa contains the
is critical to identify any mass lesion that requires lower brainstem and cerebellum.
surgical evacuation, and this objective is best achieved
by rapidly obtaining a computed tomographic (CT)
scan of the head. CT scanning should not delay patient Meninges
transfer to a trauma center that is capable of immediate
and definitive neurosurgical intervention. The meninges cover the brain and consist of three
Triage for a patient with brain injury depends on how layers: the dura mater, arachnoid mater, and pia
severe the injury is and what facilities are available mater (n FIGURE 6-2). The dura mater is a tough,

box 6-1 neurosurgical consultation for patients with tbi

When consulting a neurosurgeon about a patient with TBI, communicate the following information:
• Patient age • Presence of any focal neurological deficits
• Mechanism and time of injury • Presence of suspected abnormal neuromuscular status
• Patient’s respiratory and cardiovascular status • Presence and type of associated injuries
(particularly blood pressure and oxygen saturation) • Results of diagnostic studies, particularly CT scan
• Results of the neurological examination, including the (if available)
GCS score (particularly the motor response), pupil size, • Treatment of hypotension or hypoxia
and reaction to light • Use of anticoagulants

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