Episode 30: Head injury
10/29/18 • 45 min
https://phemcast.co.uk/wp-content/uploads/2018/10/head-injury_final.mp3
Quite a few of our previous podcasts include content which is relevant to this Head Injury one. Why not go back and have a listen to:
Episode 20: End Tidal Carbon Dioxide
Episode 28: LOST (Low Output State in Trauma)
Munroe-Kellie Doctrine
The Munroe-Kellie Doctrine is illustrated by the following pictures:
Or, alternatively, by Elfyn’s pint of Guinness analogy!
Autoregulation
Allows giraffes to drink from pools without a rush of blood to the head and eat leaves from trees without fainting.
This graph shows what happens to cerebral arterioles in uninjured brains, taken from Researchgate.net (Pires et al., 2013.)
Without autoregulation, in an injured brain, the arterioles will not change diameter in response to variations in blood pressure, and cerebral blood flow will have a linear relationship with blood pressure.
Cerebral perfusion pressure
Cerebral perfusion pressure = Mean arterial pressure – intracerebral pressure
The diameter of the arterioles, and therefore Cerebral perfusion pressure, is also affected by extremes of oxygen and carbon dioxide. If you would like to read more about this, have a look at this Life in The Fast Lane post.
References
The Brain Injury Foundation guidelines which Fliss mentions can be accessed here.
Doubts over head injury studies. Roberts I, Smith R, Evans S. BMJ. 2007 Feb 24; 334(7590): 392–394. (This is the paper Elfyn mentions regarding the now redacted original publications on the use of mannitol)
The HIRT trial: https://emj.bmj.com/content/32/11/869
The HITS-NS trial: The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.
Impact Brain Apnoea. https://www.ncbi.nlm.nih.gov/pubmed/27211834
And finally...
.... if you would like to hear more on the subject of Head Injury – have a listen to what the Resus Room team have to say about it:
https://phemcast.co.uk/wp-content/uploads/2018/10/head-injury_final.mp3
Quite a few of our previous podcasts include content which is relevant to this Head Injury one. Why not go back and have a listen to:
Episode 20: End Tidal Carbon Dioxide
Episode 28: LOST (Low Output State in Trauma)
Munroe-Kellie Doctrine
The Munroe-Kellie Doctrine is illustrated by the following pictures:
Or, alternatively, by Elfyn’s pint of Guinness analogy!
Autoregulation
Allows giraffes to drink from pools without a rush of blood to the head and eat leaves from trees without fainting.
This graph shows what happens to cerebral arterioles in uninjured brains, taken from Researchgate.net (Pires et al., 2013.)
Without autoregulation, in an injured brain, the arterioles will not change diameter in response to variations in blood pressure, and cerebral blood flow will have a linear relationship with blood pressure.
Cerebral perfusion pressure
Cerebral perfusion pressure = Mean arterial pressure – intracerebral pressure
The diameter of the arterioles, and therefore Cerebral perfusion pressure, is also affected by extremes of oxygen and carbon dioxide. If you would like to read more about this, have a look at this Life in The Fast Lane post.
References
The Brain Injury Foundation guidelines which Fliss mentions can be accessed here.
Doubts over head injury studies. Roberts I, Smith R, Evans S. BMJ. 2007 Feb 24; 334(7590): 392–394. (This is the paper Elfyn mentions regarding the now redacted original publications on the use of mannitol)
The HIRT trial: https://emj.bmj.com/content/32/11/869
The HITS-NS trial: The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.
Impact Brain Apnoea. https://www.ncbi.nlm.nih.gov/pubmed/27211834
And finally...
.... if you would like to hear more on the subject of Head Injury – have a listen to what the Resus Room team have to say about it:
Previous Episode
Episode 29: Major Incidents
https://phemcast.co.uk/wp-content/uploads/2018/07/mi.mp3
Another invitation to the Trauma Care Conference this year inspired us to combine two of the excellent speakers into this podcast considering major incidents. Thanks to both our speakers for sharing their talks from the conference.
Trauma Care offer more than the annual conference; there are monthly webinars and regional meetings too, click here for more information.
The Joint Emergency Services Interoperability Programme (JESIP) website and National Ambulance Resilience Unit (NARU) website have lots of resources to support your response to a major incident.
The papers which Chris mentions regarding IED injury patterns and management in children are both from the Journal of the Royal Army Medical Corps:
Next Episode
Episode 31: Stroke & Dizziness
https://phemcast.co.uk/wp-content/uploads/2019/01/stroke_final.mp3
The Danish mnemonic to help remember the elements of a cerebellar neurological examination:
There are lots of Youtube videos to demonstrate these signs, here are a few which I thought were particularly helpful:
If you would like to read more, there is a blog post Martin and I wrote here on the subject of dizziness, including some videos demonstrating elements of the HINTS exam, and another one from the St Emlyns team.
This is the paper Martin mentions.
Want to know more about stroke thrombolysis? Have a listen to this episode from our friends over at The Resus Room.
If you like this episode you’ll love
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