Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Trauma: traumatic brain injury
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Introduction
Head injury can be defined as any alteration in mental or physical functioning related to a blow to the head. The most affected are young adults and societal cost is significant (emotional and financial), estimated at $25 billion per annum in the USA alone, excluding inpatient costs.
Classification
▪ Neurological impairment: mild (GCS 14–15), moderate (GCS 9–13) or severe (GCS 3–8). See Trauma Scoring Systems Chapter for GCS.
▪ Anatomical: focal (extradural, subdural and intra-cerebral haematoma) vs. diffuse (concussion, multiple contusions, diffuse axonal injury (DAI), hypoxic injury).
▪ Mechanism: blunt vs. penetrating.
Incidence
180–220 cases per 100 000 population (US), approximately 600 000 each year. Of these 10% are fatal, 75% are minor, the remainder equally divided between moderate and severe. Males are affected more than females (2:1) and it is commoner in the under 35s.
Aetiology
Road accidents are the commonest cause. Also falls, occupational injuries, sports and leisure accidents. Violence and penetrating trauma increases in cities with a population >100 000.
Pathophysiology concepts
Monro-Kelly doctrine: total intra-cranial volume (1500 ml) is fixed due to the inelastic nature of the skull and is composed of brain (85–90%), blood (10%), and CSF (<3%). Cerebral oedema, haemorrhage, focal haematoma and hydrocephalus increase these components. An increase in one of these compartments will require a compensatory decrease in the others in order to maintain intracranial pressure (ICP). Normal ICP=10–15 mmHg. At the point where the compensatory mechanisms are exhausted, ICP exponentially rises (see Figure 21).
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 169 - 179Publisher: Cambridge University PressPrint publication year: 2009