Head And Spinal Cord Injury

Head and spinal cord injury • 15% of CO to the brain, with CBF of 50ml/100g/min • Pathophysiology: • TBI→ primary injury is due to hematoma, contusion, or DAI, the secondary is an exacerbation of neuronal damage from change in CBF, and systemic factors e.g. ↓BP, hypoxia, severe ↓ PCO2, anemia, ↑ temp, Sz • Hypotension is the most important factor → poor prognosis • The effect of ↑ ICP → ↓ CPP, and herniation • The Autorgulation of CBF is disrupted, but PCO2 reactivity is preserved with ↓ in magnitude, it’s very important to maintain SBP > 90 • ↑ ICP → maintain O2, adequate cerebral drain head up, adequate pain/sedation, PCO2 30, mannitol .25-1g/k, hypothermia • Anesthesia goals: o Optimize CPP, avoid ischemia, avoid drugs/tech ↑ ICP, avoid CMRO2 • Exam: GCS, pupils, brainstem reflex, focal/lateralization neuro signs • Lab: CT-head, CBC, Coags, Lytes, toxicology screen • Induction: RSI, use lido, sux , inline stabilization. • Monitors: routine, art line, CVP, ICP, temp

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Maintenance: Iso, tmep mild hypo if coags are OK Emergance: depend on the initial GCS, if good extubate in OR, avoid coughing → may give lido, Rami for extubatin , other wise to ICU. Spinal cord injury: Spinal shock→ ↓BP, ↓SVR, venous pooling, brady if above T5, resp: ↓FRC, diaphragm if above C4, ↓ FVC→ pneumonia, hypoxia, ↑ PCO2