■ Seizure prophylaxis with phenytoin to prevent early posttraumatic seizures;
indications include severe head injury, intracranial injury by CT, presence
of skull fracture
■ Antiemetics for nausea/vomiting
■ Antibiotics if penetrating injury
■ If evidence for herniation or clinical deterioration:
■ Hyperventilate to PCO 2 of 30–35 mmHg
■ Mannitol 0.25–1 g/kg IV bolus to produce osmotic diuresis
■ Emergent burr hole
■ Patients with a GCS of ≤8 usually require invasive monitoring of ICP
(either a bolt with pressure monitor placed into the subdural space or a
ventriculostomy). Ventriculostomy has the added benefit of allowing
drainage of CSF to decrease ICP.
Intracranial Hemorrhage
CEREBRAL CONTUSION
■ Usually frontal/temporal lobes
■ Contusion may be at side opposite to injury—“contrecoup.”
TRAUMATICSUBARACHNOID
■ Caused by disruption of subarachnoid vessels (see Figure 3.1)
■ Most common intracranial bleed in moderate to severe TBI (see Table 3.4)
■ Typically see HA, photophobia, and/or meningeal signs
TRAUMAFIGURE 3.1. Subarachnoid hemorrhage. Non-contrast head CT showing blood
surrounding the brainstem at the level of the midbrain (1, 2).
(Reproduced, with permission,from Tintinalli JE, Kelen GD, Stapczynski JS.Emergency
Medicine:A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1567.)