Neurosurgical rotation in h.sibu
Mr adrian teaching:
1st traumatic brain injury
What component we looking for?
1. Gcs
2. Pupillary reflex
3. Vital signs
GCS
What component in gcs?
Eye open,
E4- Spontaneous
E3- Call
E2-pain
E1-non
V-verbal
V5-orientated
V4- confused
V3-inappropriate words
V2-incomprehnsive sound
V1- no response
Motor
M6- obey command
M5- localize pain
M4- normal flexion
M3- abnormal flexion
M2- abnormal extension
M1- no response
Which GCS component is most important?
Motor !!.
Pt A-if pt eye not opening but able to obey command
Pt B -pt eye opening but unable to obey command
Which one more severe.by common sense of course pt b.
What is the important of gcs scoring?
~to triage the patient
~for referral
~ to classify the severity of the pt
+severe<=8
+ moderate9-12
+ mild 13-15
~to access whether do we need to intubate the patient or not (Airway protection)
Pupil?
What is the important?
Mass effect over the brain.always ipsilateral to the site of injury.
If pupil left 7 right 3 ,which site injure? Left side.(always ipsilateral)
+Know abit about pathway of the pupillary light reflex things.
+Uncal herniation will compress third cn.
Vital sign
what is the most important things to see? BP!!
Why???
-To access whether is there hypovolemic shock or not !
How do u access hypovolemic shock?
First sign if hypovolemic shock??
-Always tachycardia!! Seen in stage 2 of hypovolemic shock
How mny stages in hypovolemic shock?
4 stages;
Stages 1 -no clinical signs,-750ml
Stages 2- tachycardia came in, how much litre volume loss? 1.5litre!!
Stage 3-bp drop .1.5-2.0litre
Stage 4-very low bp ,more than 2 litre
What is isolated brain injury? ONLY brain injury.keyword ONLY.
What if pt presented with low BP ,hypovolemic shock ?
This is definetely not a isolated brain injury, its a polytrauma!!
Look for other source of bleeding. Because our brain dura is fixed ,only able to accomodate 30ml of blood inside.30ml of hemorrhage already can cause u dieeeee. So normally isolated brain injury ppl wont have hypovolemic shock .
Three ct scan:
1.Lacunar stroke
2. Hemorrhagic stroke
3. Mca infarct
What is lacunar infarct?
Its a SMALL infarct in basal ganglia or pons. Keyword small!!
What does lacunar stand for in latin ? Small lakes.
What is the bp that u most likely seen in lacunar infarct? Highish side .because normally they have underlying hypertension as undelying disease.but the hypertension wont high until like seen in hemorrhagic stroke like that 200/100 like that.
What gcs did u seen in lacunar stroke pt? Full gcs normally,because its only a SMALL infarct.keyword smallllll infarct!
Make sure how to see lacunar stroke in ct.
Lacunar stroke is mng by medically not under neurosurgically la.
Next is interprate a ct of hemmorrhagic stroke.
how much bp likely in this pt? Highish >200/100
Gcs in this pt? Normally drop severe.
(intracerebral hemorrhage)
Interprete ct of mca territory ischemia
-Bp of mca infarct ,also hypertensive la.highish side ,memang they underlying got hypertension, plus heart trying to compensate brain infarct .but not as high as hemorhagic that kind.
- gcs mca territory ischemia might be decreasing compare to lacunar ,why? Common sense .lacunar small .mca supply big territory. If bigger territory might affect pupillary also.and also causes uncal herniation.rmb ass effect.
Including broca area.what is broca area? Motor .
What do u access in v/s ? Pulse rate,to assess any irregular irregular, afib is the mcc any ischemia.order ecg!!
-if territory big enough,cause mass effect ,then pupil abnormality seen
1st traumatic brain injury
What component we looking for?
1. Gcs
2. Pupillary reflex
3. Vital signs
GCS
What component in gcs?
Eye open,
E4- Spontaneous
E3- Call
E2-pain
E1-non
V-verbal
V5-orientated
V4- confused
V3-inappropriate words
V2-incomprehnsive sound
V1- no response
Motor
M6- obey command
M5- localize pain
M4- normal flexion
M3- abnormal flexion
M2- abnormal extension
M1- no response
Which GCS component is most important?
Motor !!.
Pt A-if pt eye not opening but able to obey command
Pt B -pt eye opening but unable to obey command
Which one more severe.by common sense of course pt b.
What is the important of gcs scoring?
~to triage the patient
~for referral
~ to classify the severity of the pt
+severe<=8
+ moderate9-12
+ mild 13-15
~to access whether do we need to intubate the patient or not (Airway protection)
Pupil?
What is the important?
Mass effect over the brain.always ipsilateral to the site of injury.
If pupil left 7 right 3 ,which site injure? Left side.(always ipsilateral)
+Know abit about pathway of the pupillary light reflex things.
+Uncal herniation will compress third cn.
Vital sign
what is the most important things to see? BP!!
Why???
-To access whether is there hypovolemic shock or not !
How do u access hypovolemic shock?
First sign if hypovolemic shock??
-Always tachycardia!! Seen in stage 2 of hypovolemic shock
How mny stages in hypovolemic shock?
4 stages;
Stages 1 -no clinical signs,-750ml
Stages 2- tachycardia came in, how much litre volume loss? 1.5litre!!
Stage 3-bp drop .1.5-2.0litre
Stage 4-very low bp ,more than 2 litre
What is isolated brain injury? ONLY brain injury.keyword ONLY.
What if pt presented with low BP ,hypovolemic shock ?
This is definetely not a isolated brain injury, its a polytrauma!!
Look for other source of bleeding. Because our brain dura is fixed ,only able to accomodate 30ml of blood inside.30ml of hemorrhage already can cause u dieeeee. So normally isolated brain injury ppl wont have hypovolemic shock .
Three ct scan:
1.Lacunar stroke
2. Hemorrhagic stroke
3. Mca infarct
What is lacunar infarct?Its a SMALL infarct in basal ganglia or pons. Keyword small!!
What does lacunar stand for in latin ? Small lakes.
What is the bp that u most likely seen in lacunar infarct? Highish side .because normally they have underlying hypertension as undelying disease.but the hypertension wont high until like seen in hemorrhagic stroke like that 200/100 like that.
What gcs did u seen in lacunar stroke pt? Full gcs normally,because its only a SMALL infarct.keyword smallllll infarct!
Make sure how to see lacunar stroke in ct.
Lacunar stroke is mng by medically not under neurosurgically la.
Next is interprate a ct of hemmorrhagic stroke.how much bp likely in this pt? Highish >200/100
Gcs in this pt? Normally drop severe.
(intracerebral hemorrhage)
-Bp of mca infarct ,also hypertensive la.highish side ,memang they underlying got hypertension, plus heart trying to compensate brain infarct .but not as high as hemorhagic that kind.
- gcs mca territory ischemia might be decreasing compare to lacunar ,why? Common sense .lacunar small .mca supply big territory. If bigger territory might affect pupillary also.and also causes uncal herniation.rmb ass effect.
Including broca area.what is broca area? Motor .
What do u access in v/s ? Pulse rate,to assess any irregular irregular, afib is the mcc any ischemia.order ecg!!
-if territory big enough,cause mass effect ,then pupil abnormality seen
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