Head Trauma Patients Research Articles

The Incidence Rate of Cranii Base Fracture in Dr. Kariadi Hospital Semarang Period 2019

Introduction: Head injury is a major cause of death, especially in young adults and a major cause of disability. The incidence of head injuries is increasing due to the increasing use of motorized vehicles. As many as 4% of cases of head fracture occur in the base of the cranii.
 Method: This research used a descriptive observational method. The data used is secondary data taken from medical records. In this study, we wanted to know the incidence of cranii base fracture cases due to head trauma in patients treated at Dr. Kariadi period 2019.
 Result: From 29 samples of medical records obtained, 48.3% had mild head trauma, 27.6% had moderate head trauma, and 24.1% had severe head trauma. Symptoms of patients with the most clinical symptoms of cranii base fracture were raccoon eyes 51.7%, with the most fracture locations in the anterior fossa as much as 51.7%.
 Conclusion: The incidence of cranii fracture due to head trauma at RSUP Dr. Kariadi in 2019 was found mostly over 40 years old and most of them were men. The type of injury is a minor head injury, with the largest location in the anterior fossa, and the most common clinical sign found in patients with cranii fracture is raccoon eyes.

The Incidence Rate of Cranii Base Fracture in Dr. Kariadi Hospital Semarang Period 2019

Introduction: Head injury is a major cause of death, especially in young adults and a major cause of disability. The incidence of head injuries is increasing due to the increasing use of motorized vehicles. As many as 4% of cases of head fracture occur in the base of the cranii.
 Method: This research used a descriptive observational method. The data used is secondary data taken from medical records. In this study, we wanted to know the incidence of cranii base fracture cases due to head trauma in patients treated at Dr. Kariadi period 2019.
 Result: From 29 samples of medical records obtained, 48.3% had mild head trauma, 27.6% had moderate head trauma, and 24.1% had severe head trauma. Symptoms of patients with the most clinical symptoms of cranii base fracture were raccoon eyes 51.7%, with the most fracture locations in the anterior fossa as much as 51.7%.
 Conclusion: The incidence of cranii fracture due to head trauma at RSUP Dr. Kariadi in 2019 was found mostly over 40 years old and most of them were men. The type of injury is a minor head injury, with the largest location in the anterior fossa, and the most common clinical sign found in patients with cranii fracture is raccoon eyes.

Agreement of Magnetic Resonance Imaging With Computed Tomography in the Assessment for Acute Skull Fractures in a Canine and Feline Cadaver Model.

Computed tomography (CT) is the imaging modality of choice to evaluate patients with acute head trauma. However, magnetic resonance imaging (MRI) may be chosen in select cases. The objectives of this study were to evaluate the agreement of MRI with CT in the assessment for presence or absence of acute skull fractures in a canine and feline cadaver model, compare seven different MRI sequences (T1-W, T2-W, T2-FLAIR, PD-W, T2*-W, “SPACE” and “VIBE”), and determine agreement of four different MRI readers with CT data. Pre- and post-trauma CT and MRI studies were performed on 10 canine and 10 feline cadaver heads. Agreement of MRI with CT as to presence or absence of a fracture was determined for 26 individual osseous structures and four anatomic regions (cranium, face, skull base, temporomandibular joint). Overall, there was 93.5% agreement in assessing a fracture as present or absent between MRI and CT, with a significant difference between the pre and post trauma studies (99.4 vs. 87.6%; p < 0.0001; OR 0.042; 95% CI 0.034–0.052). There was no significant difference between dogs and cats. The agreement for the different MRI sequences with CT ranged from 92.6% (T2*-W) to 94.4% (PD-W). There was higher agreement of MRI with CT in the evaluation for fractures of the face than other anatomic regions. Agreement with CT for individual MRI readers ranged from 92.6 to 94.7%. A PD-W sequence should be added to the MR protocol when evaluating the small animal head trauma patient.

Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications?

Background and objectives: In patients who receive antiplatelet therapy (APT), the bleeding risk profile after mild head trauma (MHT) still needs clarification. Some studies have demonstrated an association with bleeding risk, whereas others have not. We studied the population of our level II emergency department (ED) trauma center to determine the risk of bleeding in patients receiving APT and whether bleeding results not from antiplatelet agents but rather from age. We assessed the bleeding risk, the incidence of intracranial hemorrhage (ICH) that necessitated hospitalization for observation, the need for cranial neurosurgery, the severity of the patient’s condition at discharge, and the frequency of ED revisits for head trauma in patients receiving APT. Materials and Methods: This retrospective single-center study included 483 patients receiving APT who were in the ED for MHT in 2019. The control group consisted of 1443 patients in the ED with MHT over the same period who were not receiving APT or anticoagulant therapy. Our ED diagnostic therapeutic protocol mandates both triage and the medical examination to identify patients with MHT who are taking any anticoagulant or APT. Results: APT was not significantly associated with bleeding risk (p > 0.05); as a risk factor, age was significantly associated with the risk of bleeding, even after adjustment for therapy. Patients receiving APT had a greater need of surgery (1.2% vs. 0.4%; p < 0.0001) and a higher rate of hospitalization (52.9% vs. 37.4%; p < 0.0001), and their clinical condition was more severe (evaluated according to the exit code value on a one-dimensional quantitative five-point numerical scale) at the time of discharge (p = 0.013). The frequency of ED revisits due to head trauma did not differ between the two groups. Conclusions: The risk of bleeding in patients receiving APT who had MHT was no higher than that in the control group. However, the clinical condition of patients receiving APT, including hospital admission for ICH monitoring and cranial neurosurgical interventions, was more severe.

Ultrasound assessment of optic nerve sheath diameter for evaluation of elevated intracranial pressure in patient with head trauma: A comparative study with CT head

Purpose: Increased intracranial pressure (ICP) is complication of traumatic brain injury. Early detection of raised ICP is helpful in timely treatment. Bed side ultrasound of optic nerve sheath is easier for detection of raised intracranial pressure by measuring its diameter. Our aim was to determine whether bedside ultrasound measurement of optic nerve sheath diameter (ONSD) can accurately predict raised intracranial pressure in head injury patients and to calculation of validity of test. Methods and Materials: Total 150 patients with head injury was first examined by ultrasound. The ONSD was measured 3 mm behind the globe perpendicular to long axis of globe in both eyes than mean binocular ONSD was calculated. Diameter more than 5 mm was considered abnormal. CT scan was performed in all patients and result was considered positive for elevated ICP if mid line shift, effacement of sulci, ventricles and cisterns are seen. Results: Out of total 150 patients 61 was female and 89 was male, age was ranging from 23-61 years. 30 patients showed mean binocular ONSD >5mm by ultrasound out of them 26 patients showed positive signs of raised intracranial pressure on CT. Sensitivity and negative predictive value of ultrasound to detect raised ICP was 100%, Specificity was 96.7 % and negative predictive value was 86.6 %. Conclusions: Ultrasound can be used as bed side screening tool to detect raised ICP in ICU patients and head trauma patients especially in hospital with high patient flow in emergency department.

A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings

To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings. This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3years (n=183 and n=237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included "higher risk" patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models. Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P=.11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P=.05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P=.22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs 78%→73%, P=.01), and potential cases of missed abusive head trauma (40%→21% vs 29%→32%, P=.003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%→7% vs 11%→13%, P=.22). PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings. ClinicalTrials.gov: NCT03162354.

A cohort retrospective study on computed tomography scan among pediatric minor head trauma patients

ObjectivesComputed tomography (CT) scan is commonly performed in head trauma patients to identify severity of the brain injury. However, the role of clinical signs and consciousness is critical in deciding the need of CT scan, in order to avoid unnecessary exposure to X-ray radiations. The aim of this study was to evaluate the incidence of positive CT findings in our pediatric population referred to our center with minor head trauma and its correlation with clinical signs and symptoms. MethodIn this retrospective study, children aged under 15 years presented to our center within 6 h of minor head trauma from 2019 to 2020 were included. CT findings, demographic data, Glasgow Coma Scale (GCS) and clinical sign were extracted from patient data file. Positive CT scan patients were further evaluated in terms of GCS and signs and symptoms. The data were analyzed using SPSS v25. ResultOf 380 children included, the most common findings from CT scan were fractures (11.8%), SAH (subarachnoid hemorrhage) (6.1%), and ICH (intracerebral hemorrhage) (5.5%). 18.7% of total children had positive CT findings. Nausea and vomiting, seizure, racoon eyes, battle sign and GCS less than 15 were positively associated with positive CT finding. Mechanism of trauma and age group were not associated with positive CT. ConclusionsClinical signs should be observed among the patients along with level of consciousness before CT scan. Further studies are required to design a precise algorithm and guidelines regarding the use of CT scan among pediatric minor head trauma patients.

Predictors for Direct to Operating Room Admission in Severe Trauma

BackgroundProtocols for expediting critical trauma patients directly from the helipad to the operating room tend to vary by center, rely heavily on physician gestalt, and lack supporting evidence. We evaluated a population of severely injured trauma patients with the aim of determining objective factors associated with the need for immediate surgical intervention. MethodsAll highest-activation trauma patients transported by air ambulance between 1/1/16 and 12/31/17 were enrolled retrospectively. Transfer, pediatric, isolated burn, and isolated head trauma patients were excluded. Patients who underwent emergency general surgery within 30 min of arrival without the aid of cross-sectional imaging were compared to the remainder of the cohort. ResultsOf the 863 patients who were enrolled, 85 (10%) spent less than 30 min in the emergency department (ED) before undergoing an emergency operation. The remaining 778 patients (90%) formed the comparison group. The ED ≤ 30 min group had a higher percentage of penetrating injuries, lower blood pressure, and was more likely to have a positive FAST exam. The “Direct to Operating Room” (DTOR) score is a predictive scoring system devised to identify patients most likely to benefit from bypassing the ED. The odds ratio of emergency operation within 30 min of hospital arrival increased by 2.71 (95% confidence interval 2.23-3.29; P < 0.001) for every 1-point increase in DTOR score. ConclusionsTrauma patients with profound hypotension or acidosis and positive FAST were more likely to require surgery within 30 min of hospital presentation. Use of a scoring system may allow early identification of these patients in the prehospital setting by nonphysician providers.

Posttraumatic arachnoid cyst rupturę and delayed acute subdural hygroma

Introduction. Subdural hygromas (SDGs) are the accumulation of fluid in the subdural space. Arachnoid cysts (ACs) on the other hand are common cerebrospinal fluid (CSF) containing lesions of the central nervous system, located within the subarachnoid space. They are generally found incidentally on neuroimaging studies and remain asymptomatic throughout the life. Rupture into the subdural space resulting in subdural hygroma (SDG) is relatively rare. Aim. We aimed to show the importance of the radiological follow up in head trauma patients having large ACs. Description of the case. We report a case of a 69-year-old male patient with a known large Galassi type III AC, presented to our hospital with traumatic brain injuries and re-presented with acute posttraumatic SDG in association with AC rupture. Conclusion. This case emphasizes the importance of radiological follow up in head trauma patients having large ACs to reveal and appropriately manage traumatic subdural collections.

The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma.

Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB).Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance.Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival.Conclusion: The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

Comparison of Emergency medicine physician’s decision and Pecarn scale suggestions on pediatric head trauma patients

Comparison of Emergency medicine physician’s decision and Pecarn scale suggestions on pediatric head trauma patients

Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil ref lex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).

The Evaluation of Frequency of Intracranial Haemorrhage in Patients of Head Trauma with GCS 10-15 on Computed Tomography Scan

The Evaluation of Frequency of Intracranial Haemorrhage in Patients of Head Trauma with GCS 10-15 on Computed Tomography Scan

Increasing Risks of Suicide Attempt and Suicidal Drug Overdose After Head Trauma in Patients With Sleep-Disordered Breathing: A Population-Based Study.

Objective: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) after head trauma in patients with sleep-disordered breathing (SDB) by using the National Health Insurance Research Database of Taiwan.Methods: We analyzed the data of patients aged ≥20 years who were diagnosed with SDB between 2000 and 2012. We further divided them into two cohorts [with admission for head injury (SBI) and without (SBN)], and we compared them against sex-, age-, comorbidity-, and index-date-matched healthy individuals. The adjusted hazard ratios (aHRs) and 95% confidence intervals of SA and SDO were calculated with adjustment of age, sex, and comorbidities.Results: Approximately 0.61% of patients among the overall 142,063 patients with SDB had SA, with 535 and 335 patients included in the SBN and SBI cohorts, respectively. Compared with patients with SBN, a significantly higher risk of SA was observed in patients with SBI (aHR = 2.22), especially in those aged under 50 years (aHR = 2.48). Notably, a SDO incidence of 1.20% was noted in patients with SDB, and the SBI cohort had a 1.81-fold higher risk for SDO when compared with the SBN cohort.Conclusion: The risks of subsequent SA and SDO are proportionally increased by the effects of head trauma with a moderating role of SDB, especially in those aged <50 years. SDB and head trauma can increase suicide behaviors individually and synergistically.

Evolution of paediatric head trauma patients with CT; The requirement of computed tomography in children with head injury: a cross-sectional study

INTRODUCTION: In this study, we aimed to reveal the cranial computed tomography (CT) results of paediatric head trauma cases taken in our hospital and what clinical variables might be related to pathology in cranial CT. MATERIAL AND METHODS: Age, gender, glasgow coma scale (GCS), open or suspicious skull fracture, vomiting≥ 2, retrograde amnesia ≥ 30 minutes, the detailed mechanism of injury and CT findings (if CT is available)were evaluated. RESULTS: 66 of the cases were female (35.7%) and 119 were male (64.7%). The ages of the patients vary between 0 and 16 and the average age is 6.76. 108 (58.4%) of the patients had admitted to the hospital with traumas resulted from falling. 33 (17.8%) of them were passengers of a four-wheeled vehicle and 15 (8.1%) were had been crashed with a four-wheeled vehicle. CONCLUSIONS: In paediatric head traumas, falls and traffic accidents are in the first place and the measures taken in this regard should be increased.

Thyroid Storm in Head and Neck Emergency Patients.

Background: Thyroid storm is a rare but life-threatening emergency that prompts urgent intervention to halt its potentially disastrous outcomes. There is not much literature available on thyroid storm in head neck trauma and non-thyroid/parathyroid head neck surgery. Due to rarity of thyroid storm in head and neck trauma/surgery patients, its diagnosis becomes challenging, is often misdiagnosed and causes delay in the diagnosis and management. Therefore, the aim of this work was to compile, analyze and present details to develop a consensus and augment available literature on thyroid storm in this group of patients. Materials and methods: A comprehensive literature search of the last 30 years was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index for thyroid storm using MeSH words and statistical analyses were performed. Results: Seven articles describing seven cases of thyroid storm were reviewed. All patients required medical management and one patient (14.3%) required adjunctive surgical management. Burch and Wartofsky Diagnostic criteria for thyroid storm were used in diagnosis of 42% patients. Time of diagnosis varied from immediately upon presentation to formulating a retrospective diagnosis of having a full-blown thyroid storm at 4 days post presentation. It was misdiagnosed and unthought of initially in majority of these cases, (71.4%) were not diagnosed in the first day of hospital stay. Conclusion: Early recognition of thyroid storm in head and neck patients markedly reduce morbidity/mortality. Albeit unexpected, it should be ruled out in any symptomatic head and neck trauma or post-surgery patient.

The Use of Rotterdam CT Score for Prediction of Outcomes in Pediatric Traumatic Brain Injury Patients Admitted to Emergency Service

Introduction: Rotterdam CT score for prediction of outcome in traumatic brain injury is widely used for patient evaluation. The data on the assessment of pediatric traumatic brain injury patients with the Rotterdam scale in our country are still limited. In this study, we aimed to evaluate the use of the Rotterdam scale on pediatric trauma patients in our country and assess its relationship with lesion type, location and severity, trauma type, and need for surgery. Methods: A total of 229 pediatric patients admitted to the emergency service due to head trauma were included in our study. Patients were evaluated in terms of age, gender, Glasgow Coma Scale (GCS), initial and follow-up Rotterdam scale scores, length of stay, presence of other traumas, seizures, antiepileptic drug use, need for surgical necessity, and final outcome. Results: A total of 229 patients were included in the study, and the mean age of the patients was 95.8 months. Of the patients, 87 (38%) were girls and 142 (62%) were boys. Regarding GCS at the time of admission, 59% (n = 135) of the patients had mild (GCS = 13–15), 30.6% (n = 70) had moderate (GCS = 9–12), and 10.5% (n = 24) had severe (GCS < 9) head trauma. The mean Rotterdam scale score was calculated as 1.51 (ranging from 1 to 3) for mild, 2.22 (ranging from 1 to 4) for moderate, and 4.33 (ranging from 2 to 6) for severe head trauma patients. Rotterdam scale score increases significantly as the degree of head injury increases (p < 0.001). Discussion: With the adequate use of GCS and cerebral computed tomography imaging, pediatric patients with a higher risk of mortality and need for surgery can be predicted. We recommend the follow-up of pediatric traumatic brain injury patients with repeated CT scans to observe alterations in Rotterdam CT scores, which may be predictive for the need for surgery and intensive care.

Attention Deficit Hyperactivity Disorder (ADHD) in Patients with and without Head Trauma.

PurposeAttention deficit hyperactivity disorder (ADHD) in adults is one of the psychological problems that can increase the risk of accidents and trauma, especially head trauma. Recent studies have reported the frequency of adult attention deficit hyperactivity disorder (ADHD) among trauma patients. Adult AD0HD has been reported in trauma patients. In the present study, we hypothesized that adult ADHD was more common among head trauma patients following an accident compared to a group without trauma.Materials and MethodsIn this case-control study, 230 patients with head injuries and 460 non-trauma patients were selected. The adult Connors self-report screening scale (CAARS-SV) was used to screen for ADHD. Three subscales as subscale A (attention deficit index), subscale B (hyperactivity index) and subscale D (ADHD index) were evaluated between the two groups. Using linear multiple regression analysis, the effect of group, age, gender, and socioeconomic variables on ADHD scores was evaluated.ResultsThe total frequency of adult ADHD was 9.5%, which was equal to 1.6% in the trauma group and 9.5% in the non-trauma group. The experimental group had more drivers as the job (11.7% vs 3.7%, P<0.001) compared to the control group. Of the Connors subscales, only the D subscale was significantly lower in the case group than in the control group (6.35 6 5.11 vs 51.72 4 72.4, P=0.003). The prevalence of ADHD in patients with head trauma and non-trauma head injury was 6.1% and 5.9%, respectively, which did not show a statistically significant difference (P=0.9). Linear regression analysis showed that the subscale D only had a significant relationship with group and age. However, by entering variables in logistic regression analysis, it was observed that only the age variable was significant in the presence of other variables.ConclusionAccording to the results of the present study, the frequency of adult ADHD in trauma patients, as a screening diagnosis, was not found to be higher than non-traumatic patients.

Incidence of Cerebral Hemorrhage in Traumatic Patients using Computed Tomography in Tabuk City, Saudi Arabia

Computed Tomography (CT) is the most commonly used imaging modality in the evaluation of cerebral hemorrhage in the head trauma patients. Objective: To study the incidence of a cerebral hemorrhage in traumatic patients using computed tomography. Method: This retrospective study was conducted at King Khalid hospital in Tabuk city, Saudi Arabia, in the radiology department, in the period from September 2018 to April 2020. The study was done by collecting 471 CT reports of patients all of them were exposed to head trauma with deferent reasons. The data were analyzed by Statistical Package for the Social Sciences (SPSS) program (ver. 20) and presented in tables and graphs according to the checklist which includes: patient age, gender, type of trauma, CT finding, and type of hemorrhage. Results: The most age group suffered from head trauma was less than 20 years percentage (55%), The male patients more exposed to head trauma than female patients with percentage (84.5%), the road traffic accident (RTA) is the most common type of trauma by percentage (63.5%), according to the CT finding; the cerebral hemorrhage represented (15.5%) with the highest percentage in a subdural hematoma (31.2%), the fracture represented (2.8%) while the normal appearance represented (81.7%) as the highest percentage. Conclusion: Most of the traumatic brain injury in patients caused cerebral hemorrhage and the CT scan reports show that: the common type of cerebral hemorrhage is subdural hematoma and it is common in males which exposed to (RTA) in the age group (21 - 40) years old.

Initial Assessment and Stabilisation of the Head Trauma Patient

Head trauma cases can be a daunting emergency to be faced with. These patients require an efficient and thorough assessment and have specific nursing requirements. In order to achieve a positive outcome, it is therefore important that nurses feel confident in identifying the signs that indicate deterioration and are able to alert the veterinary surgeon to them. It is also vital that nurses know the best way to be prepared for the patient's admission to the practice. The principles of the initial assessment are to triage any life-threatening presenting conditions and limit the effects of the secondary trauma to reduce intracranial pressure. The mainstay of stabilising these patients requires intensive nursing care, intravenous therapy, hyperosmolar therapy and pain management. This article discusses the pathophysiology, initial nursing interventions and considerations for the initial assessment and stabilisation of head trauma cases.