Collection
Built automatically
From across the library
Not curated by a person
Traumatic Brain Injury
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Based on the third iteration of Management of Traumatic Brain Injury in Children published in Pediatric Critical Care Medicine, there is no clear consensus that decompressive craniectomy improves outcomes. — Pramod Pulaamba, Traumatic Brain Injury · 8:15
Traumatic Brain Injury
Listen →
Dr. Pramod Puligandla, Traumatic Pediatric Surgeon and Intensivist at Montreal Children’s Hospital, joins the Stay Current Team to review the Cliff Notes on traumatic brain injury (TBI).Dr. Pramod Puligandla, Traumatic Pediatric Surgeon and
podcast14:04 · Dec 2020
40 mL/kg (or 4 units of packed cells) remains a validated threshold for failure of non-operative management, supported by both expert opinion and military experience data — David, Solid Organ Injury Management: Update Course 2017 · 32:00
Solid Organ Injury Management: Update Course 2017
Watch →
At the 5th Annual Stay Current Pediatric Surgery Update Course in 2017, Dr. David Notricadiscusses solid organ injury management in the pediatric patient. He focuses on evaluation and management of the patient, including shock index-pediatr
video32:57 · Sep 2018
Centers that report good outcomes with distal pancreatectomy for pancreatic trauma are those with surgeons who are very comfortable operating on the pancreas and do it frequently. — Todd Ponsky, Pediatric Trauma With Dr. Richard Falcone · 24:40
Pediatric Trauma With Dr. Richard Falcone
Listen →
Discussion with Dr. Richard Falcone that touches on multiple topics in pediatric trauma.
podcast56:05 · Jan 2019
Expert statements from the recordings in this collection.
Solid Organ Injury Management: Update Course 2017
A normal shock index is less than 1 or less than 0.9, with adjustments now available for pediatric patients
David7:00
The shock index allows clinicians not regularly seeing pediatric patients to assess for shock without knowing normalized blood pressure values for children
David7:30
Massive transfusion protocol must be activated as soon as massive bleeding is recognized, not after reaching a specific threshold, to make a difference in outcome
David9:00
FAST (Focused Assessment with Sonography for Trauma) examines four specific areas: three in the abdomen and one in the pericardial sac, looking only for hemoperitoneum or pericardial effusion, not organ injury
David13:00
FAST has lost appeal in stable pediatric trauma patients because it misses too many injuries, as shown by the PECARN Group study
FAST remains useful in unstable patients as a replacement for diagnostic peritoneal lavage (DPL)
The ATOMAC guideline divides patients into stable and unstable categories: stable patients can be transfused to hemoglobin >7 and discharged when bleeding stops; unstable patients who don't respond to packed cells and fluids need operative intervention
Young children with head injury are often hypotensive even without active bleeding, while some bleeding children are not hypotensive, making it difficult to define 'stable' vs. 'unstable'
David21:00
Hypotension due to solid organ injury is ominous, with significant risk of death and failure of non-operative management
David22:00
In younger children (not teenagers), blood pressure less than 50 mmHg is a really ominous sign with high risk of poor outcome
David22:30
Teenagers and adults can become hypotensive, respond to blood transfusion, and often be managed non-operatively, unlike younger children
David23:00
Adult studies show that ideal blood pressure after head injury is much higher than previously thought, with blood pressure of 150-160 mmHg associated with better outcomes than 90-120 mmHg, suggesting Cushing's reflex may be protective
In patients with traumatic brain injury and shock, resuscitation should be managed based on cerebral perfusion pressure rather than absolute blood pressure when intracranial monitoring is in place
David25:00
The ATOMAC guideline was modified 8 months into the prospective study to specify that recurrent hypotension or lack of sustained response to packed cells constitutes failure of non-operative management, after a patient with multiple injuries died following recurrent hypotension in the PICU
The ATOMAC guideline effectively guided care for 1,007 pediatric trauma patients in the prospective validation study
David28:00
Only about half of children in shock are hypotensive, meaning shock does not necessarily equal low blood pressure in pediatric patients
David28:30
40 mL/kg (or 4 units of packed cells) remains a validated threshold for failure of non-operative management, supported by both expert opinion and military experience data
Blood evacuated from the chest via chest tube may originate from abdominal bleeding through a ruptured diaphragm, making it difficult to determine whether chest tube output should count toward the 40 mL/kg solid organ injury transfusion threshold
David32:30
Traumatic Brain Injury
Traumatic brain injury caused over 837,000 visits, hospitalizations, and deaths in children in 2014.
For a patient with small epidural hematoma, immediate neurosurgical consultation is needed to determine if surgical evacuation is required.
Pramod Pulaamba1:08
Small epidurals may be managed with repeat CT scan in several hours or clinical observation for deterioration rather than immediate surgery.
Pramod Pulaamba1:25
ICP monitoring should be discussed with neurosurgeons for patients being managed for potential intracranial pressure issues.
Pramod Pulaamba1:40
Invasive blood pressure monitoring is needed for accurate blood pressure identification in patients with intracranial hypertension.
Pramod Pulaamba1:58
Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure.
Pramod Pulaamba2:20
Most guidelines suggest keeping cerebral perfusion pressure greater than 45 mmHg as minimal acceptable, sometimes 55 mmHg in children.
ICP above 20 may require ongoing treatment and/or reevaluation with imaging.
Pramod Pulaamba2:42
Acute intracranial hypertension may first manifest as dilation of the ipsilateral pupil or progressive bradycardia with hypertension.
Pramod Pulaamba3:00
Acute ICP management includes raising head of bed to improve venous drainage, providing oxygen, and bag valve masking.
Pramod Pulaamba3:15
Hyperventilation to PCO2 of around 35 helps vasoconstrict the brain and reduce ICP.
Pramod Pulaamba3:35
Opening an ICP drain is one of the first interventions to evacuate fluid and reduce pressure.
Pramod Pulaamba3:50