HEAD INJURIES WHATS NEWDr. P. UPENDER GOWD, MD.,DA PROFESSOR & H O D DEPARTMENT OF ANEASTHESIOLOGY GANDHI MEDICAL COLLEGE SECUNDERABAD

PREAMBLEANNUAL INCIDENCE OF TRAUMA26.5 MILLIONSTRIMODAL DEATHS4-5% - HEAD INJURIES( 1 MILLION )27% DEATHS (

HEAD INJURIES WHATS NEWPRE - HOPITAL MANAGEMENTCRITICAL TRANSPORT PRIMARY SURVEYINITIAL MANAGEMENTSECONDARY SURVEYDEFINITIVE TREATMENT

HEAD INJURIES WHATS NEWGLASGOW COMA SCALE

EYE OPENING 1,2,3,4VERBAL RESPONSE 1,2,3,4,5MOTOR RESPONSE 1,2,3,4,5,6

HEAD INJURIES WHATS NEWAIRWAY MANAGEMENT

PREVENTION OF HYPOXIAMECHANICAL VENTILATIONNORMO CARBIA

HEAD INJURIES WHATS NEWCIRCULATION

RESUSCITATION TO NEAR NORMAL BPMEAN ARTERIAL PRESSURE 90mm HgCEREBRAL PERFUSION PRESSUREINTRACRANIAL PRESSURE

HEAD INJURIES WHATS NEW

CPP=MAP-ICP60 -70 mm Hg

HEAD INJURIES WHATS NEWINTRACRANIAL PRESSURE

(a) BRAIN PARENCHYMA (b) INTERSTITIAL AREA(c) BLOOD VOLUME(d) CEREBRO SPINAL FLUID

HEAD INJURIES WHATS NEWCEREBRAL METABOLISM

OXYGEN CONSUMPTIONCEREBRAL BLOOD FLOW COMPENSATION AUTO REGULATION ISCHAEMIA

HEAD INJURIES WHATS NEWASSESSMENT AND MANAGEMENT

ASSOCIATED INJURIES 60%COMPREHENSIVE TRAUMA LIFE SUPPORT (C T L S) GUIDELINESPRE-HOSPITAL STABILAZATIONENDOTRACHEAL INTUBATION (R S I)OXYGENATION (FIO2 SaO2 95%)

HEAD INJURIES WHATS NEW

PaCO2 32 TO 35 mm HgINTRAVENOUS FLUIDS NORMAL SALINEHYPERTONIC SALINE 7.5%

HEAD INJURIES WHATS NEWMONITORING CEREBRAL PERFUSION

INTRACRANIAL PRESSUREICP < 20 mm HgINVASIVE ICP MONITORING

INTRAVENTRICULAR

PARENCHYMALEPIDURALSUBDURAL CATHETER

SUBDURAL SCREW

HEAD INJURIES WHATS NEWMONITORING OXYGEN EXTRACTIONJUGULAR OXIMETRY 55% - 75%75% PARANCHYMAL INABILITYTISSUE OXYGEN PRESSURE by POLAROGRAPHIC CATHETERNORMAL 15-30 (Lower Value Poor Progno

HEAD INJURIES WHATS NEWNEWER THERAPEUTIC MODULESACTIVATION OF IMMUNE MECHANISMDRUGS Cyclosporin Mitochon PermeabCannabinoids- Dexanabinol-ExcitotoxicityRosuvastatin Post Injury AmnesiaMelatonin - Free Radical ScavengerProgesterone Mod TBI Reduced 57% Deaths

HEAD INJURIES WHATS NEWLONG TERM DRUG THERAPYDantrolene /Diazepam Dystonia Intrathecal BACLOFENBotulinum ToxinDonepezil - Visual & Verbal MemoryLevodopa

HEAD INJURIES WHATS NEW

GENE THERAPY( miRNA , siRNA )TRANSPLANT NEURAL STEM CELLSIMPROVE NEUROGENESISNEUROTROPHIC FACTOR LEVELSIMPROVES BEHAVIORAL OUTCOMES

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