CRITICAL CARE QUIZ:CASE:13: TRAUMATIC BRAIN INJURY MANAGEMENT IN - TopicsExpress

CRITICAL CARE QUIZ:CASE:13: TRAUMATIC BRAIN INJURY MANAGEMENT IN ICU:- A 32 years old man was brought to ER after road traffic accident. He had traumatic brain injury with stable vitals. GCS 9/15, E4 V1 M4, pupils round,regular, sluggish response to light. weakness on left side chest clear, S1 & S2 normal, no added sounds, soft distended abdomen.Rest of body showed minor injuries and no fractures. CT showed a subdural hematoma with midline shift, he was shifted to OT, operated immediately and after surgery shifted to SICU on mechanical ventilator. CVP passed in Rt SCV. Jugular venous oxygen saturation(SJvO) monitoring catheter was inserted in right IJV. NGT,Foleys,Tracheostomy was done.In ICU, he was kept on ventilator and he returned to baseline preop clinical status in 8 hours after surgery. for 3days. GCS 9/10, E4, M5. For last 4 hours, he has deteriorated, GCS 5/10, E2,M3, right pupil dilated left constricted but both reactive round, pulse 170/min, BP 117/76 mmHg, MAP 75mmHg, CVP 12cm, SJVO 94%, CBC,Electrolytes,RFTs,LFTs,Calcium,albumin,phosphorus,Cultures all normal. Input 4500ml.output 2800ml. ECG shown.Repeat CT brain shows mild to moderate hydrocephalus.Mannitol bolus was given twice, no response. To lower his ICP, which of the following is the best next option? A) Hypertonic saline 23.4% QID. B) Pentobarbital bolus then infusion. C) Therapeutic Hypothermia 33-35C. D) Inj dexamethasone 12mg stat then 4mg 4hourly. E) Controlled Hyperventilation on ventilator F) External Ventricular Drain Insertion.

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