By Joseph H. Miller (auth.), Charles J. Long, Leslie K. Ross (eds.)

Providing an intensive number of information about medical points of head harm from acute care to restoration, this treatise interrelates a number of neural specialties and broadens the rehabilitation strategy to incorporate the family.

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Extra info for Handbook of Head Trauma: Acute Care to Recovery

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If these lesions are neither revealed nor suspected, one considers continued use of steroids, antibiotics, and mannitol. During treatment with mannitol, urinary output should be measured every hour and electrolytes measured every 6 h. If the basal cisterns are absent on the CAT scan, but a surgical lesion is not present and the patient remains acutely ill from increased intracranial pressure, then the intracranial pressure is monitored. pH Changes The next parameter to be evaluated in the unconscious patient is the change in blood pH (hydrogen ion concentration).

The trend now is to have the CAT scanner in the emergency department in order to avoid delays in the ongoing treatment and allow immediate scanning. The results of the CAT scan may provide the treating physician with significant MANAGEMENT AND EVALUATION OF HEAD TRAUMA 7 diagnostic information. If a patient has changes in the level of consciousness and is acutely ill from increased intracranial pressure, certain CAT scan results indicate the need for immediate surgery. These include (1) epidural hematoma, (2) subdural hematoma, (3) lobar or opercular intracerebral hematoma, (4) cerebellar hematoma, or (5) cerebellar infarct.

Continued) debridement as well as removal of bony and missile fragments within the brain parenchyma. Additional pathology is often present, such as contusion and intracerebral and extracerebral hematomas. These lesions are removed at the time of local wound debridement and decontamination. Closure of the dura is important to avoid CSF fistula and further contamination. Patient selection for surgical intervention is important. Those patients presenting with a Glasgow coma score of 3 have been demonstrated to have lethal injuries and should be managed without surgical intervention (Clark, Muhlbauer, Watridge, & Ray, 1986).

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