Management of Patient with Traumatic Brain Injury: Epidural Hematoma
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Traumatic Brain Injury (TBI) is defined as “an alteration in brain function or other evidence of brain pathology, caused by external force” (Menon et al., Arch Phys Med Rehabil 91(11):1637–40, 2010). TBI is a major cause of death and disability across the world causing significant economic impact in both developed and developing nations. In the USA alone, more than 50,000 people die annually from TBI and accounts for 2.2 million emergency department visits annually (Centers for Disease Control and Prevention, https://www.cdc.gov/traumaticbraininjury/data/rates.html, 2001–2010). TBI is classified as mild (>13), moderate (9–12), or severe (<9) based on the Glasgow Coma Scale (GCS) (Teasdale and Jennett, Lancet 2(7872):81–4, 1974). The cause of TBI varies with age, with falls being more common in the very young (0–14 years) and older (>45 years) and motor vehicle accidents and assaults being more common in the 5–24 year group (Centers for Disease Control and Prevention, https://www.cdc.gov/traumaticbraininjury/data/rates.html, 2001–2010). Prevention of secondary injuries such as hypotension and hypoxia can significantly affect outcome, and anesthesiologists, emergency room physicians, and critical care physicians play a major role in the management during the secondary phase of TBI. Epidural Hematoma (EDH) is a serious complication resulting from head injury when bleeding into the space between the dura and skull occurs. Acute EDH with symptoms is a neurologic emergency which often requires operative intervention.
KeywordsTraumatic brain injury Epidural hematoma Secondary injuries Intracranial pressure Management Brain trauma foundation
- 1.Menon DK, Schwab K, Wright DW, Maas AI, Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91(11):1637–40.CrossRefGoogle Scholar
- 2.Centers for Disease Control and Prevention, N. C. f. I. P. a. C., Division of Unintentional Injury Prevention Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2001–2010. https://www.cdc.gov/traumaticbraininjury/data/rates.html.
- 20.Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.CrossRefGoogle Scholar
- 29.Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119–30.CrossRefGoogle Scholar
- 31.Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hebert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.CrossRefGoogle Scholar
- 34.Coles JP, Fryer TD, Coleman MR, Smielewski P, Gupta AK, Minhas PS, Aigbirhio F, Chatfield DA, Williams GB, Boniface S, Carpenter TA, Clark JC, Pickard JD, Menon DK. Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism. Crit Care Med. 2007;35(2):568–78.CrossRefGoogle Scholar
- Phan RD, Bendo AA. Perioperative management of adult patients with severe head injury. Cottrell and Patel’s neuroanesthesia, 6th ed. Elsevier; 2017. Chapter 19. p. 326–36.Google Scholar