Module 4: Pediatric Head Injuries

Slide 1 - Learning ObjectivesSlide 2 - Pediatric Head Injury - EpidemiologySlide 3 - Intracranial Pressure - PhysiologySlide 4 - Raised ICP - Brain HerniationSlide 5 - CPP - PhysiologySlide 6 - Head Injury - PathophysiologySlide 7 - Respiratory Failure in Head-Injured ChildrenSlide 8 - Signs and Symptoms of Head InjurySlide 9 - Glasgow Coma Scale (GCS)Slide 10 - Glasgow Coma Scale (GCS) in Infants and ChildrenSlide 11 - Classification of Head Injury (HI) by GCSSlide 12 - AVPU Pediatric Response Scale for DisabilitySlide 13 - Common Lesions After Head InjurySlide 14 - Subdural HematomaSlide 15 - Epidural HematomaSlide 16 - Intracerebral HematomaSlide 17 - Management of Head InjurySlide 18 - Hypotension Associated with Poor OutcomeSlide 19 - Management of Raised ICPSlide 20 - HyperventilationSlide 21 - Ventilation - RecommendationSlide 22 - Fluid Therapy for Head InjurySlide 23 - Sedation, Analgesia and ParalysisSlide 24 - Use of Paralytic AgentsSlide 25 - Positioning Tips to Reduce ICPSlide 26 - Temperature RegulationSlide 27 - Management of SeizuresSlide 28 - AnticonvulsantsSlide 29 - Anticonvulsant ProphylaxisSlide 30 - Hyperosmolar TherapySlide 31 - Ventricular Catheter/ Lumbar Drain for Draining CSF to Reduce ICPSlide 32 - Decompressive CraniotomySlide 33 - Barbiturate ComaSlide 34 - Summary of ICP ManagementSlide 35 - Non-Accidental Injury (Shaken Baby Syndrome)Slide 36 - Shaken Baby SyndromeFamily Risk FactorsSlide 37 - Bruises - Abuse or Accident?Slide 38 - Evaluation of Suspected AbuseSlide 39 - Evaluation of Suspected AbuseSlide 40 - Child Abuse - The Physician's RoleSlide 41 - Review: Question 1Slide 42 - Review: Question 2Slide 43 - Review: Question 3Slide 44 - Review: Question 4Slide 45 - Review: Question 5Slide 46 - Acknowledgments of 46

Fluid Therapy for Head Injury

• Euvolemia should be maintained with either normal saline or lactated Ringer's solution.
• Use isotonic IV solutions containing ≥ 130 meq/L Na+
• Hypertonic (3%) saline or mannitol may be indicated to decrease ICP
• Monitor serum glucose -- hyperglycemia (Glu > 200) and hypoglycemia (Glu < 60) should be avoided (both are associated with worse neurological outcomes)
• Glucose (e.g., D5W) is rarely needed for children older than 6 months and should be used only with documented hypoglycemia

Module 4: Pediatric Head Injuries

Ventilation - Recommendation

Sedation, Analgesia and Paralysis