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Increased Intracranial Pressure in Closed Head Injury

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1. Increased Intracranial Pressure in Closed Head Injury

Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse (...) Cancer Administration 4 Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Aka: Increased Intracranial Pressure in Closed Head Injury , Increased Intracranial Pressure in Trauma , Severe Head Trauma Related Increased Intracranial Pressure From Related Chapters II. Differential Diagnosis III. Pathophysiology with secondary IV. Signs: Findings indicating management below >15 mm Severe (GCS 8 or less) Cerebral edema Severe Severe Hypopnea V

2018 FP Notebook

2. Increased Intracranial Pressure in Closed Head Injury

Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse (...) Cancer Administration 4 Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Aka: Increased Intracranial Pressure in Closed Head Injury , Increased Intracranial Pressure in Trauma , Severe Head Trauma Related Increased Intracranial Pressure From Related Chapters II. Differential Diagnosis III. Pathophysiology with secondary IV. Signs: Findings indicating management below >15 mm Severe (GCS 8 or less) Cerebral edema Severe Severe Hypopnea V

2017 FP Notebook

3. Predicting severe brain injuries from apparent minor head trauma without a scan

of these patients present to the emergency department with a high level of consciousness on the GCS. The injury is occult and patients may deteriorate later as intracranial bleeding and intracranial pressure increase. Older people are particularly at risk due to age related cerebral atrophy. This review highlights that no single clinical feature in alert head injury patients can be used to rule out life threatening traumatic brain injury. However, to CT scan all head trauma patients is costly. Clinical Decision (...) , and pedestrians struck by motor vehicles, may help identify patients at increased risk of severe intracranial injuries. The Glasgow Coma Scale (GCS) is used to assess the severity of head injuries based on the state of consciousness of a person. It assigns the best eye opening, verbal response, and motor scores up to a total of 3-15 points, where three is least conscious and 15 is totally alert. Clinical decision rules included in this study: New Orleans Criteria Older than 60 years Intoxication Headache Any

2019 NIHR Dissemination Centre

4. Shaken baby syndrome or non-accidental head injury caused by shaking

/July 2017 14 ? Transcranial Doppler: it makes it possible to non-invasively indicate IH, and to guide a possible decision for emergency surgery. ? When a neurosurgical procedure is necessary, a macroscopic description (appearance/pressure) and a cytological analysis of the samples from the cerebrospinal fluid and haematoma must be carried out. 1.3 Differential diagnoses for NAHI caused by shaking The main differential diagnosis is accidental head injury, but in this case the clinical history must (...) . The following mechanisms and circumstances were examined: ? shaking without impact; ? mild head injury caused by a fall from a low height; ? play; ? childbirth; ? hypoxia or anoxia; ? resuscitation manoeuvres. The update looked at other mechanisms mentioned: vaccinations, dehydration, thrombosis of the intracranial venous sinuses and haemostasis disorders. 2.1 Shaking without impact Shaking is a highly violent action during which the cervical spine suffers brutal whiplash. Subdural bleeding and RH

2017 HAS Guidelines

5. Assessing the Accuracy and the Impact of Standard-practice Ventricular Drainage on Intracranial Pressure Measurements Following Traumatic Brain Injury

Measures Go to Primary Outcome Measures : Evaluate the need for an optimized device that can simultaneously measure intracranial pressure and drain CSF without requiring potentially harmful clamping. [ Time Frame: 6 months ] Investigators want to find a better device that can measure pressure in the head after a traumatic brain without causing an increase in pressure inside of the head. Secondary Outcome Measures : Compare clinical practices regarding intermittent versus continuous monitoring during (...) Assessing the Accuracy and the Impact of Standard-practice Ventricular Drainage on Intracranial Pressure Measurements Following Traumatic Brain Injury Assessing the Accuracy and the Impact of Standard-practice Ventricular Drainage on Intracranial Pressure Measurements Following Traumatic Brain Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved

2016 Clinical Trials

6. Unexpected results from a trial of therapeutic hypothermia for severe head injury

of a serious brain injury. Intracranial pressure is the pressure inside the skull. Swelling or bleeding in or around the brain as a result of head injury can increase pressure, causing damage to the brain or restricting blood supply. Controlled cooling of the body (induced or therapeutic hypothermia) is used to reduce intracranial pressure. However, the evidence for its effectiveness is unclear. The NIHR funded this trial to help doctors decide whether whole body cooling should continue to be used (...) brain injury). The long-term effects of traumatic brain injury can vary widely in severity, but can include problems with communication, cognition (problem-solving) and emotional changes. An estimated one million people live with the long-term effects of a serious brain injury. Intracranial pressure is the pressure inside the skull. Swelling or bleeding in or around the brain as a result of head injury can increase pressure, causing damage to the brain or restricting blood supply. Controlled cooling

2018 NIHR Dissemination Centre

7. Predicting severe brain injuries from apparent minor head trauma without a scan

of these patients present to the emergency department with a high level of consciousness on the GCS. The injury is occult and patients may deteriorate later as intracranial bleeding and intracranial pressure increase. Older people are particularly at risk due to age related cerebral atrophy. This review highlights that no single clinical feature in alert head injury patients can be used to rule out life threatening traumatic brain injury. However, to CT scan all head trauma patients is costly. Clinical Decision (...) , and pedestrians struck by motor vehicles, may help identify patients at increased risk of severe intracranial injuries. The Glasgow Coma Scale (GCS) is used to assess the severity of head injuries based on the state of consciousness of a person. It assigns the best eye opening, verbal response, and motor scores up to a total of 3-15 points, where three is least conscious and 15 is totally alert. Clinical decision rules included in this study: New Orleans Criteria Older than 60 years Intoxication Headache Any

2018 NIHR Dissemination Centre

8. CRACKCast E041 – Head Injury

and Cerebral Edema Congestive brain swelling Increased intracranial blood volume due to hyperemia caused by vasodilation needed to maintain increased metabolic needs of damaged brain tissue after head injury Cerebral edema Absolute increase in cerebral water content Diffuse cerebral edema may occur with a head injury, but does NOT correlate with the severity of head injury 3 findings: loss of sulci, loss of grey-white interface and collapsed ventricles Vasogenic edema Failure of the BBB endothelial (...) rule? What are the inclusion criteria. What is the New Orleans CT head rule? What are the inclusion criteria? Which test is more sensitive? More specific? (adapted from: ) What is the Canadian CT head rule? From CJEM: Primary Outcome: Need for neurological intervention, defined as need for neurologic intervention as death within 7 days due to the head injury or need with 7 days for craniotomy, elevation of skull fracture, intracranial pressure monitoring, or intubation for head injury. ~ from

2016 CandiEM

9. Unexpected results from a trial of therapeutic hypothermia for severe head injury

of a serious brain injury. Intracranial pressure is the pressure inside the skull. Swelling or bleeding in or around the brain as a result of head injury can increase pressure, causing damage to the brain or restricting blood supply. Controlled cooling of the body (induced or therapeutic hypothermia) is used to reduce intracranial pressure. However, the evidence for its effectiveness is unclear. The NIHR funded this trial to help doctors decide whether whole body cooling should continue to be used (...) brain injury). The long-term effects of traumatic brain injury can vary widely in severity, but can include problems with communication, cognition (problem-solving) and emotional changes. An estimated one million people live with the long-term effects of a serious brain injury. Intracranial pressure is the pressure inside the skull. Swelling or bleeding in or around the brain as a result of head injury can increase pressure, causing damage to the brain or restricting blood supply. Controlled cooling

2018 NIHR Dissemination Centre

10. Validation of Non-invasive Absolute Intracranial Pressure Monitoring

: is to assess the correlation of intracranial pressure (ICP) measurement in patients after traumatic brain injury and subarachnoid hemorrhage between simultaneous, non-invasive measurement and standard, invasive,measurement Condition or disease Intervention/treatment Intracranial Pressure Increase Traumatic Brain Injury Device: Vittamed 205 Detailed Description: Currently, ICP (Intracranial Pressure) can be measured only using invasive techniques. In a previous (pilot study) a non-invasive technique (...) : Kienzler Jenny Collaborator: Swiss National Science Foundation Information provided by (Responsible Party): Kienzler Jenny, Kantonsspital Aarau Study Details Study Description Go to Brief Summary: Primary objective of this study is to assess the accuracy and precision of intracranial pressure (ICP) measurement in patients after traumatic brain injury and subarachnoid hemorrhage when using simultaneous, non-invasive measurement compared to standard, invasive, measurement. Secondary objective

2017 Clinical Trials

11. Early Management of Head Injury in Adults

is present: 38, level III • obvious evidence of penetrating head injury (involving skull bone and structure beneath it) • skull fracture visualised beneath scalp laceration wound • clinical signs suggestive of skull base fracture Closed fracture is diagnosed when skull depression is detected by scalp palpation with or without overlying scalp swelling or hematoma. Skull fracture is an important finding to predict intracranial lesion following MHI which require a head CT. • If skull fracture is present (...) patients who are intubated and ventilated. • In mild to moderate head injury: ? analgesia should be used to control pain ? short-acting sedative agent may be offered in titrated dose to control agitation/restlessness • Naloxone may be used as opioid reversal in head injury. • Isotonic crystalloid is the preferred choice of intravenous fluid in head injury. • Mannitol, hypertonic saline or frusemide may be used to reduce intracranial pressure in head injury after consultation with a specialist

2015 Ministry of Health, Malaysia

12. Prostacyclin Affects the Relation Between Brain Interstitial Glycerol and Cerebrovascular Pressure Reactivity in Severe Traumatic Brain Injury. (PubMed)

of glycerol, a marker of cell membrane damage, are associated with PR, and if prostacyclin, a membrane stabilizer and regulator of the microcirculation, may affect this association in a beneficial way.Patients suffering severe traumatic brain injury (sTBI) were treated according to an intracranial pressure (ICP)-targeted therapy based on the Lund concept and randomized to an add-on treatment with prostacyclin or placebo. Inclusion criteria were verified blunt head trauma, Glasgow Coma Score ≤ 8, age 15-70 (...) Prostacyclin Affects the Relation Between Brain Interstitial Glycerol and Cerebrovascular Pressure Reactivity in Severe Traumatic Brain Injury. Cerebral injury may alter the autoregulation of cerebral blood flow. One index for describing cerebrovascular state is the pressure reactivity (PR). Little is known of whether PR is associated with measures of brain metabolism and indicators of ischemia and cell damage. The aim of this investigation was to explore whether increased interstitial levels

2019 Neurocritical care Controlled trial quality: uncertain

13. Head injury

of intracranial pathology is rare after mild traumatic brain injury, and usually occurs within 24 hours of the injury. A deterioration in clinical state 21 days after a head injury is very rare, occurring in only 0.1% of cases [ ]. The SIGN guideline on the early management of head injury recommends urgent reassessment of the person if there is a severe or increasing headache or persistent vomiting [ ]. Management of persistent non-specific symptoms The SIGN guideline on brain injury rehabilitation recommends (...) is estimated to occur in 33–50% of all people following traumatic brain injury, and may be caused by haemorrhage, raised intracranial pressure, oedema, skull fracture, or direct insult to the pituitary gland. Symptoms are often non-specific and overlap with post-concussion symptoms. Rare life-threatening complications include sodium dysregulation and adrenal crisis. Depression and anxiety A large single cohort study (n = 559) found that 53.1% of people met the criteria for depression at some point

2016 NICE Clinical Knowledge Summaries

14. Anti-secretory Factor as a Treatment for Adults With Severe Traumatic Head Injury

of the vessels into the extra-cellular space. The accumulation of fluid will lead to an increase in distance between the cell and its closest capillary, which may lead to energy failure and intra-cellular edema. The extra volume of the fluid leads to increased intracranial pressure, which in turn leads to an increase in blood pressure, aggravating the edema. In addition to the physiological changes that occur, the edema will be increased by the immunological response to the tissue damage with release of pro (...) -inflammatory cytokines that give rise to both extra- and intra-cellular edema. Today, no treatment has been proven efficient against traumatic brain edema. AF - anti-secretory factor is a 41 kDa protein that exists in humans and most animals. It was discovered due to its ability to inhibit experimental diarrhea. AF has been proven to have an effect on Mb Menière and glaucoma. In animal models, AF has been proven efficient in reducing increased intracranial pressure caused by trauma and virus infection

2017 Clinical Trials

15. Suxamethonium (succinylcholine) for RSI and intubation in head injury

Modified: 14th August 2012 Status: Green (complete) Three Part Question In [patients with traumatic brain injury], does [suxamethonium] [significantly increase intracranial pressure]? Clinical Scenario You are the middle grade doctor attending a patient with an isolated head injury in the Emergency Department. The GCS on arrival is now E2V2M4 (8/15). There is a history of vomiting en route to the hospital. The anaesthetist present agrees that the patient should be intubated following rapid sequence (...) induction for CT scan; while you are pre-oxygenating another middle grade appears and helpfully reminds you that "suxamethonium will only increase this patient's intracranial pressure." You wonder whether the evidence is compelling enough to avoid suxamethonium altogether in patients with head injury. Search Strategy Ovid MEDLINE® 1948 to September 09 2011 EMBASE® 1980 to present Cochrane Database exp Succinylcholine/ OR suxamethonium.mp OR depolarising muscle relaxant*.mp OR anectine.mp AND exp

2012 BestBETS

16. Appropriate Use Criteria: Imaging of the Head & Neck

by audiometric testing (15 dB or greater at 2 consecutive frequencies between 0.5 and 3 kHz) ? Hearing loss associated with at least one neurologic sign or symptom known to increase the pretest probability of a retrocochlear lesion ** requires contraindication to MRI Horner’s syndrome** ** requires contraindication to MRI Hydrocephalus/ventricular assessment Diagnosis of suspected increased intracranial pressure or hydrocephalus Management of ventricular shunt Infectious disease Diagnosis or management (...) are not considered abnormalities on neurologic exam) ? Neck or facial pain (concern for dissection)—see Dissection indication in CTA/MRA Head guideline ? Neck stiffness and fever—see Infectious disease and Inflammatory disease indications ? Risk factors for venous thrombosis—see Venous thrombosis indication Patient Populations High-risk vascular patient ? Age over 50 years with new onset of headache ? Known malignancy ? Increased genetic risk for intracranial neoplasms (including basal cell nevus syndrome

2018 AIM Specialty Health

17. Management of Severe Head Injury

Avoid or VIII. Management: Increased Intracranial Pressure See Link includes key Severe Head Injury management IX. Management: Seizures Observe for non-convulsive Observe for fine extremity or recurrent facial tics Acute control See Start with s (e.g. , ) (esp. for intracranial bleeding) No benefit in children if no immediate Agents ( ) Mixed data on outcomes, but easier than other agents to dose with less level monitoring Phenobarbital X. Management: Hypotension is a concerning finding in the face (...) Management of Severe Head Injury Management of Severe Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Management of Severe

2018 FP Notebook

18. Head Injury

in pediatric Closed Head Injury Signs See Vault CSF or Hemotympanum Post-auricular ( ) Orbital (Raccoon's Eyes) CN VII palsy ( ) Signs Intracranial Injury Focal Diffuse Mild Classic s with Risk of significant blood loss to the point of (especially children) Apply direct pressure to prevent further bleeding Close bleeding scalp lesions quickly (even temporarily) with s, staples or Raney Clips Carefully investigate for associated complications prior to final closure (deformity, bony fragments, CSF leakage (...) , Closed Head Injury , Craniocerebral Trauma , Traumatic Brain Injury From Related Chapters II. Epidemiology : 1.7 Million tic brain injuries in U.S. per year in 75% of cases Hospitalizations: 275,000 Deaths: 52,000 III. Pathophysiology (ICP) association with injury Note measurements are in mmHg, not cmH2O Normal: 10 mmHg ICP Abnormal: 20 mmHg ICP Severe: 40 mmHg ICP tion: 50 mmHg ICP Hypertensive response in face of increased ICP Helps maintain cerebral perfusion Do not use antihypertensives to lower

2018 FP Notebook

19. Acute Kidney Injury (AKI)

of venepuncture) until at least 48 hours after the period of increased risk has elapsed (1D) ? out-patients deemed at high risk of AKI should be closely monitored for AKI if there has been a new exposure. This should include regular monitoring of the serum creatinine until at least 48 hours after the period of increased risk has elapsed. For paediatric patients, monitoring should be undertaken by secondary care but may be in an out-patient or in-patient setting depending on clinical circumstances (1D). 3 (...) : patients with newly diagnosed AKI who are managed in the community should have their urea and electrolytes monitored regularly until renal function has returned to baseline or has stabilised in order to detect progressive or recurrent AKI in a timely fashion (1D) Renal Association Clinical Practice Guideline Acute Kidney Injury (AKI) - August 2019 8 4. Management of the patient with AKI and at increased risk of it Guideline 4.1 – Adults and Paediatrics These recommendations apply to patients at high

2019 Renal Association

20. Assessment of traumatic brain injury, acute

=bestpractice.com Fabbri A, Servadei F, Marchesini G, et al. Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions. J Neurol Neurosurg Psychiatry. 2008 Oct;79(10):1180-5. http://www.ncbi.nlm.nih.gov/pubmed/18356255?tool=bestpractice.com Clinical guidelines in Australia recognise the increased morbidity associated with a GCS of 13, and limit the classification of mild TBI to those patients with a GCS of 14 or 15. New South Wales Ministry of Health. Closed head (...) include the following: Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008 Aug;7(8):728-41. http://www.ncbi.nlm.nih.gov/pubmed/18635021?tool=bestpractice.com Cerebral oedema Increased intracranial pressure (ICP) Haemorrhage Seizures Ischaemia Infection. Epidemiology of TBI TBI is a substantial cause of morbidity and mortality, leading to more than 2 million accident and emergency department visits annually in the US, Coronado VG, McGuire LC

2018 BMJ Best Practice

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