Management of Closed Head Injuries - Critical Care Videos

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Management of Closed Head Injuries

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James P. Moises, MD, Assistant Clinical Professor of Surgery, Department of Emergency Medicine, Clerkship Director of Emergency Medicine, Tulane University Hospital and Clinic, discusses the management for closed head injuries.

References and Resources
Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am. 2007 Aug;25(3):655-78, viii. Review.

De Souza M, Moncure M, Lansford T, et al. Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less? J Trauma. 2007 Aug;63(2):370-2.

Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG. Controversies in the evaluation and management of minor blunt head trauma in children. Curr Opin Pediatr. 2007 Jun;19(3):258-64. Review.

James Moises Videos on The Doctor’s Channel:
Tales From the ER
Status of Current Pediatric Emergency Care
Agitated Patients in the ER

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Dr. Paul W. (9 weeks ago)
I agree with everything said in this video. However, there are other avenues of approach. I believe, and there is some literature on this, that the use of SPECT (Ceretec) scans that demonstrate cerbral hypoperfusion identifies candidates for cerebral vasodilation, ie. the use of nimodipine. This calcium channel blocker, known for dilating cerebral arteries/arterioles, can benefit patients with traumatic brain injury (TBI), because these patients have vasospasm causing a realtive degree of ischemia. Objective improvement can be measured with follow up SPECT scans to demonstrate that the prior areas of hypoperfusion show increased and/normal perfusion. The latter typically corresponds to clinical improvement. All signs and symptoms improve. This form of treatment will help improve outcome when bleeding of any type is seen on scanning, or without macroscopic evidence (there is always micoscopic bleeding in the brain in trauma,which may not be seen macroscopically on conventional scanning). Paul Wand, M.D. Clincal Neurology Coral Springs, Fl. paulwandmd@yahoo.com 954-344-9772
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