A Case HEAD INJURY with sub dural hematomaoperated .pptx

case presentation of head injury

1. CASE OF HEAD INJURY
Presented by:
Capt Pradeep
Dept of Surg

2. HISTORY
36yearsoldservingsoldier
BroughtwithallegedH/Ofallfromrunningvehicle
TOI:2330on28June2019
POI:About50KmfromDehradun.
Initiallymanagedatacivilhospital.
FirstAidgivenandreftohigherNeuroSurgicalCentre

3. On Arrival at MH Dehradun
At0400hrs:UnconsciouswithH/omultipleepisodesof
vomiting
Pulse:54/min
BP:142/86mmHg
Temp:Afebrile
SpO2:96%inroomair
GCS:E1M3V1
Pupil:Rtpupilsluggishlyreacting,Ltpupilmiddilatedand
nonreacting
Chest/Abdomen/Pelvisandlimbs-NAD

4. At MI ROOM
Airwayassessedandpatientintubated
Breathingandoxygenationmaintained
CirculationensuredandtwolargeIVcannulainserted
IVfluid(NS)started
Philadelphiacollarsecured
AnyDeficitevaluated
BloodsampletakenforHemat,Biochemandcrossmatch
ShiftedforCTScan

5. Urgent NCCT Head
LtFTPSDHof16mmandlargeparenchymalcontusionin
LtFTPregion.
Masseffectwithmidlineshiftof16mmcausingSubfalcine
andUncalherniationwitheffacementofbasalcistern.
Focalparenchymalbleedinrightcerebralhemisphere.
Verticalundisplayedfractureofrightoccipitalbone.

7. What We Did
PatientunderwentEmergencyFTPDecompressive
Craniectomyonearlymorningof29June2019
PerOpfindings:
EDH(10ml)
SDH(20ml)
TenseDura
NonPulsatilebrain
Postevacuationofhematoma:returnofbrainpulsation
ShiftedtoICUforPostOpcare

9. Post Op Progress
Generalconditionimproved
Noinotropicsupport
RTfeedsstarted
Bestsupportivecaredeliveredtopatient
Antibiotics
Anti-edema
Anti-epileptics
Highproteindiet
Chestandlimbphysiotherapy
Goodanalgesia

10. Repeat SCANS
01July2019
CompleteresolutionofLtFTPSDHwithdecreaseinmidline
shift.
IncreaseinperilesionaledemainLtFTPregion

11. 12July2019
NearcompleteresolutionofLTFTPSDHwithoutsignificant
midlineshift.Decreaseinintraparenchymalbleed.
Herniationofbrainmatterthroughcraniotomysite.

12. 23July2019
MRIBrain:Ex-vacuodilationofLtlateralventricle.LtFTP
edema.MinimalSDHwithoutmidlineshift.
MinimalintraparenchymalHgewithperilesionedema.
Noaxialherniation.

13. 25July2019:PateinttransferredtoCHCC(Lucknow)for
neurosurgeon’sopinionwithGCSE4M6VT
PatienttransferredbackforIn-HospitalConvalascenceand
intervalreviewbyNeurosurgeon
TracheostomyClosedon

14. Presentstatus

15. ANY QUESTIONS
???????????