scholarly journals Improved Hemodynamic Status of Head Injured Patients in the Emergency Unit (ER): Literature Review

2021 ◽  
Vol 11 (04) ◽  
pp. 173-180
Author(s):  
Dadi Hamdani ◽  
Fida Husain
Keyword(s):  
Head Injury ◽  
Literature Review ◽  
Head Injuries ◽  
Head Position ◽  
Inclusion Criteria ◽  
Hemodynamic Status ◽  
Head Injured ◽  
Keywords Head Injury ◽  
Injured Patients ◽  
The Brain

Background: Head injury is a serious problem that can lead to death and even death. Handling of head injuries starts from protecting the brain with blood flow to the brain so that hypoxia or brain ischemia does not occur. Hemodynamics is the result of measuring systolic and diastolic blood pressure, pulse rate, and respiratory rate. Objectives: This literature review aims to find out what interventions can be done when there is an increase in hemodynamic status in head injury patients Methods: This database search was conducted by searching on google scholars with the keywords head injury, hemodynamics. The inclusion criteria of this literature review are articles that were researched within the last 5 years with the year published 2015-2020, full text, using the Indonesian language, the article that used is the article. Results: Interventions that can be done when there is an increase in hemodynamic status in head injury patients are giving oxygen and increasing 30o, giving oxygen through a simple mask and head position 30o, giving head-up position 30o compared to 15o position, giving nasal prong oxygenation therapy and murotal therapy Al-Qur'an for 30 minutes 3 times/day. Conclusion: All interventions resulting from this literature review were in the form of giving oxygen and increasing the head 30o, giving oxygen through a simple mask and head position 30o, giving the head position 30o compared to 15o position, giving nasal branch oxygenation therapy, and murotal Al-Qur'an therapy for 30 minutes 3 times/day.

Golf Related Head Injuries in Children: The Little Tigers

1998 ◽  
Vol 43 (5) ◽  
pp. 139-140 ◽  
Author(s):  
A.C. McGuffie ◽  
M.O. Fitzpatrick ◽  
D. Hall
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Emergency Departments ◽  
Head Injuries ◽  
Western Society ◽  
Accident And Emergency ◽  
Head Injured ◽  
Accident And Emergency Department ◽  
Injured Patients

Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. 1 Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre.2 Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department3 or a regional neurosurgical centre.2 This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.

scholarly journals “Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

2020 ◽  
Vol 11 ◽  
pp. 395
Author(s):  
Nishant Goyal ◽  
Srikant Kumar Swain ◽  
Kanav Gupta ◽  
Jitender Chaturvedi ◽  
Rajnish Kumar Arora ◽  
...  
Keyword(s):  
Head Injury ◽  
Head Injuries ◽  
Radiological Diagnosis ◽  
Associated Injuries ◽  
Injury Patterns ◽  
Demographic Profile ◽  
Head Injured ◽  
Injured Patients

Background: As citizens have been forced to stay home during coronavirus disease of 2019 (COVID-19) pandemic, the crisis created unique trends in the neurotrauma patterns with changes in mode, severity, and outcome of head injured patients. Methods: Details of neurotrauma admissions under the neurosurgery department at our institute since the onset of COVID-19 pandemic in the country were collected retrospectively and compared to the same period last year in terms of demographic profile, mode of injury, GCS at admission, severity of head injury, radiological diagnosis, management (surgical/conservative), and outcome. The patients were studied according to which phase of pandemic they were admitted in – “lockdown” period (March 25 to May 31, 2020) or “unlock” period (June 1 to September 15, 2020). Results: The number of head injuries decreased by 16.8% during the COVID-19 pandemic. Furthermore, during the lockdown period, the number of admissions was 2.7/week while it was 6.8/week during the “unlock” period. RTA was the mode of injury in 29.6% patients during the lockdown, while during the unlock period, it was 56.9% (P = 0.000). Mild and moderate head injuries decreased by 41% and severe head injuries increased by 156.25% during the COVID-19 pandemic (P = 0.000). The mortality among neurotrauma patients increased from 12.4% to 22.5% during the COVID-19 era (P = 0.009). Conclusion: We observed a decline in the number of head injury admissions during the pandemic, especially during the lockdown. At the same time, there was increase in the severity of head injuries and associated injuries, resulting in significantly higher mortality in our patients during the ongoing COVID-19 pandemic.

scholarly journals Does Teleradiology Improve Inter-hospital Management of Head-Injury?

1997 ◽  
Vol 24 (3) ◽  
pp. 235-239 ◽  
Keyword(s):  
Head Injury ◽  
Adverse Events ◽  
Hospital Management ◽  
District General Hospital ◽  
Therapeutic Interventions ◽  
Head Injured ◽  
Hospital Transfer ◽  
Group 2 ◽  
Injured Patients ◽  
Group 1

ABSTRACT:Objective:In many countries, neurosurgical care is concentrated in regional centres, which often necessitates the inter-hospital transfer of patients with head injury for optimal treatment. The aim of this study was to evaluate the role of teleradiology in the management of head-injured patients when referred from a district general hospital to a tertiary neurosurgical centre.Methods:Prospective data were collected over a fifteen month period from March '95 to May '96. Head-injured patients referred without the facility of teleradiology (Group 1), were compared to similar patients referred with teleradiologie images (Group 2), with particular regard to therapeutic intervention before transfer and adverse events during transfer.Results:There were 28 patients in Group 1 and 35 in Group 2, of which 31 were transferred. Both groups were comparable with respect to age, admission Glasgow Coma Scale score, and intracranial pathology. For patients transferred with teleradiology consultation (Group 2), therapeutic interventions were more (32.1% vs. 10.7%, p = 0.06), adverse events during transfer were significantly lower (6.4% vs. 32.1%, p = 0.01), and transfer time was reduced (72 vs. 80 minutes, p = 0.38). Four patients in Group 2 were treated by a mobile neurosurgical team at the referring hospital because of rapid clinical deterioration.Conclusion:Our findings indicate that teleradiology has an important role in improving inter-hospital management of head-injured patients.

Impairment of helper T-cell function and lymphokineactivated killer cytotoxicity following severe head injury

1991 ◽  
Vol 75 (5) ◽  
pp. 766-773 ◽  
Author(s):  
Keith B. Quattrocchi ◽  
Edmund H. Frank ◽  
Claramae H. Miller ◽  
Asim Amin ◽  
Bernardo W. Issel ◽  
...  
Keyword(s):  
T Cell ◽  
Head Injury ◽  
Severe Head Injury ◽  
Cell Cytotoxicity ◽  
Content Type ◽  
Lak Cell ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Infection is a major complication of severe head injury, occurring in 50% to 75% of patients who survive to hospitalization. Previous investigations of immune activity following head injury have demonstrated suppression of helper T-cell activation. In this study, the in vitro production of interferon-gamma (INF-γ), interleukin-1 (IL-1), and interleukin-2 (IL-2) was determined in 25 head-injured patients following incubation of peripheral blood lymphocytes (PBL's) with the lymphocyte mitogen phytohemagglutinin (PHA). In order to elucidate the functional status of cellular cytotoxicity, lymphokine-activated killer (LAK) cell cytotoxicity assays were performed both prior to and following incubation of PBL's with IL-2 in five patients with severe head injury. The production of INF-γ and IL-2 by PHA-stimulated PBL's was maximally depressed within 24 hours of injury (p < 0.001 for INF-γ, p = 0.035 for IL-2) and partially normalized within 21 days of injury. There was no change in the production of IL-1. When comparing the in vitro LAK cell cytotoxicity of PBL's from head-injured patients and normal subjects, there was a significant depression in LAK cell cytotoxicity both prior to (p = 0.010) and following (p < 0.001) incubation of PBL's with IL-2. The results of this study indicate that IL-2 and INF-γ production, normally required for inducing cell-mediated immunity, is suppressed following severe head injury. The failure of IL-2 to enhance LAK cell cytotoxicity suggests that factors other than decreased IL-2 production, such as inhibitory soluble mediators or suppressor lymphocytes, may be responsible for the reduction in cellular immune activity following severe head injury. These findings may have significant implications in designing clinical studies aimed at reducing the incidence of infection following severe head injury.

scholarly journals Mitigating the Consequences of Subconcussive Head Injuries

2020 ◽  
Vol 22 (1) ◽  
pp. 387-407
Author(s):  
Eric A. Nauman ◽  
Thomas M. Talavage ◽  
Paul S. Auerbach
Keyword(s):  
Head Injury ◽  
Clinical Diagnosis ◽  
Head Injuries ◽  
Tissue Level ◽  
Clinical Neurology ◽  
Subconcussive Injury ◽  
History Of ◽  
Tissue Alteration ◽  
The Brain

Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.

Prediction tree for severely head-injured patients

1991 ◽  
Vol 75 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Sung C. Choi ◽  
Jan P. Muizelaar ◽  
Thomas Y. Barnes ◽  
Anthony Marmarou ◽  
Danny M. Brooks ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Predictive Accuracy ◽  
Head Injuries ◽  
Pupillary Response ◽  
Prognostic Indicators ◽  
Critical Threshold ◽  
Content Type ◽  
Intermediate Outcomes ◽  
Head Injured ◽  
Injured Patients

✓ Prediction tree techniques are employed in the analysis of data from 555 patients admitted to the Medical College of Virginia hospitals with severe head injuries. Twenty-three prognostic indicators are examined to predict the distribution of 12-month outcomes among the five Glasgow Outcome Scale categories. A tree diagram, illustrating the prognostic pattern, provides critical threshold levels that split the patients into subgroups with varying degrees of risk. It is a visually useful way to look at the prognosis of head-injured patients. In previous analyses addressing this prediction problem, the same set of prognostic factors (age, motor score, and pupillary response) was used for all patients. These approaches might be considered inflexible because more informative prediction may be achieved by somewhat different combinations of factors for different patients. Tree analysis reveals that the pattern of important prognostic factors differs among various patient subgroups, although the three previously mentioned factors are still of primary importance. For example, it is noted that information concerning intracerebral lesions is useful in predicting outcome for certain patients. The overall predictive accuracy of the tree technique for these data is 77.7%, which is somewhat higher than that obtained via standard prediction methods. The predictive accuracy is highest among patients who have a good recovery or die; it is lower for patients having intermediate outcomes.

scholarly journals Word-finding strategies in closed head injured adults

1988 ◽  
Vol 35 (1) ◽  
Author(s):  
Juleen Kleiman ◽  
Lesley Bucke
Keyword(s):  
Head Injury ◽  
Closed Head Injury ◽  
Differential Effectiveness ◽  
Language Deficit ◽  
Word Finding ◽  
Confrontation Naming ◽  
Wide Range ◽  
Head Injured ◽  
Closed Head ◽  
Injured Patients

Word-finding difficulties are a common and prominent language deficit following closed head injury. The word-finding difficulties of three closed head injured patients were investigated within the framework of compensatory strategies using Teicher's Taxonomy of Word-Finding Strategies (Teicher, 1986). The word-finding difficulties were evaluated during procedural discourse and two confrontation naming conditions. Each subject's communicative competence and language ability was determined. Results indicated that all subjects employed a wide range of strategies, particularly during confrontation naming, but with differential effectiveness. A relationship was noted between the strategy's effectiveness and the subject's pragmatic ability. The results are discussed in the light of the existing literature on head injury. The theoretical and clinical implications are considered.

Resuscitation of Hypotensive Head-Injured Patients: Is Hypertonic Saline the Answer?

2008 ◽  
Vol 74 (3) ◽  
pp. 253-259
Author(s):  
Jose L. Pascual ◽  
Eileen Maloney-Wilensky ◽  
Patrick M. Reilly ◽  
Corinna Sicoutris ◽  
Michael K. Keutmann ◽  
...  
Keyword(s):  
Brain Tissue ◽  
Hypertonic Saline ◽  
Trauma Center ◽  
Tissue Oxygenation ◽  
Perfusion Pressure ◽  
Inclusion Criteria ◽  
Brain Tissue Oxygenation ◽  
Head Injured ◽  
Level I ◽  
Injured Patients

Hypertonic saline (HTS) may decrease intracranial pressure (ICP) in severe traumatic brain injury (STBI) and effectively resuscitates hypotensive patients. No data exist on institutional standardization of HTS for hypotensive patients with STBI. It remains unclear how HTS affects brain tissue oxygenation (PbtO2) in STBI. We hypothesized HTS could be safely standardized in patients with STBI and would lower ICP while improving cerebral perfusion pressure (CPP) and PbtO2. Under institutional guidelines in a Level I trauma center, 12 hypotensive STBI intensive care unit subjects received HTS. Inclusion criteria included mean arterial pressure (MAP) ≤ 90 mmHg, Glasgow Coma Scale (GCS) ≤ 8, ICP ≥ 20 mmHg, and serum [Na+] < 155 mEq/L. All patients underwent ICP monitoring. Hemodynamics, CPP, ICP, and PbtO2 data were collected before and hourly for 6 hours after HTS infusion. Guideline criteria compliance was greater than 95 per cent. No major complications occurred. Mean ICP levels dropped by 45 per cent (P < 0.01) and this drop persisted for 6 hours. CPP levels increased by 20 per cent (P < 0.05). PbtO2 remained persistently elevated for all time points after HTS infusion. Institutional use of HTS in STBI can be safely implemented in a center caring for neurotrauma patients. HTS infusion in hypotensive STBI reduces ICP and raises CPP. Brain tissue oxygenation tends to improve after HTS infusion.

High-risk mild head injury

1997 ◽  
Vol 87 (2) ◽  
pp. 234-238 ◽  
Author(s):  
John N. K. Hsiang ◽  
Theresa Yeung ◽  
Ashley L. M. Yu ◽  
Wai S. Poon
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Mild Head Injury ◽  
Radiographic Findings ◽  
Content Type ◽  
Head Injured ◽  
Definition Of ◽  
Gcs Score ◽  
Injured Patients ◽  
Fine Print

✓ The generally accepted definition of mild head injury includes Glasgow Coma Scale (GCS) scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. The current definition of mild head injury is misleading because patients classified in this category can have severe sequelae. Therefore, a prospective study of 1360 head-injured patients with GCS scores ranging from 13 to 15 who were admitted to the neurosurgery service during 1994 and 1995 was undertaken to modify the current definition of mild head injury. Data regarding patients' age, sex, GCS score, radiographic findings, neurosurgical intervention, and 6-month outcome were collected and analyzed. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury. There was a statistically significant trend across GCS scores for percentage of patients with positive acute radiographic findings, percentage receiving neurosurgical interventions, and percentage with poor outcome. The presence of postinjury vomiting did not correlate with findings of acute radiographic abnormalities. Based on the results of this study, the authors divided all head-injured patients with GCS scores ranging from 13 to 15 into mild head injury and high-risk mild head injury groups. Mild head injury is defined as a GCS score of 15 without acute radiographic abnormalities, whereas high-risk mild head injury is defined as GCS scores of 13 or 14, or a GCS score of 15 with acute radiographic abnormalities. This more precise definition of mild head injury is simple to use and may help avoid the confusion caused by the current classification.

Use of Intraoperative Ultrasonography to Improve the Diagnostic Accuracy of Exploratory Burr Holes in Patients with Traumatic Tentorial Herniation

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 345-347 ◽  
Author(s):  
Brian T. Andrews ◽  
Joshua B. Bederson ◽  
Lawrence H. Pitts
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Ct Scanning ◽  
Intraoperative Ultrasonography ◽  
Burr Hole ◽  
Ultrasound Images ◽  
Frontal Pole ◽  
Subdural Hematomas ◽  
Head Injured ◽  
Injured Patients

Abstract Seventeen head-injured patients with signs of brain stem compression at admission underwent emergency bilateral burrhole exploration before computerized tomographic (CT) scanning. After exploration of the epidural and subdural spaces, real-time ultrasonography was performed intraoperatively to identify intraaxial hematomas. Epidural or subdural hematomas were identified surgically in 11 patients (65%) and immediately evacuated through a craniotomy; in 2 patients, bilateral subdural hematomas were removed. Ultrasonography showed no evidence of intracerebral mass lesions in 14 (82%) of the 17 patients, demonstrated extensive contusions of the temporal lobe in 2 patients (prompting partial lobectomy in both cases), and revealed a small intraparenchymal hematoma deep within the dominant hemisphere, which was not removed, in 1 patient. The sensitivity of ultrasound images for identifying intraparenchymal lesions was evaluated postoperatively by CT or autopsy. In 15 patients (88%), the results of ultrasonography were confirmed. In 2 (12%), CT scans showed small but significant lesions at the frontal pole missed by ultrasonography; one patient had a residual subdural hematoma, and the other a small intraparenchymal hemorrhage. These results confirm that patients with clinical evidence of brain stem compression soon after head injury often have extraaxial hematomas that can be readily identified by burr-hole exploration. Although intraparenchymal hematomas are rare immediately after head injury, they can ususally be identified by intraoperative ultrasonography. This simple technique can reduce the risk of missing intractranial hematomas during emergency burr-hole exploration and improve intraoperative decision making in this population of severely head-injured patients.

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