A 72 year old male has been brought to your emergency room after being removed from a motor vehicle, which has been involved in a high speed collision. He is moaning, his eyes are closed and he withdraws to pain.
On transfer to the CT scanner his left pupil dilates.
Describe your management.作者: shenxiu2 时间: 2009-12-10 20:41 本帖最后由 shenxiu2 于 2009-12-11 09:41 编辑
In exams, you will need to demonstrate that you understand the significance of the "unilateral pupil dilatation "---which is increased ICP . And then all the managements will aim at decreasing ICP ----resuscitation, intubation , sedation , paralysis, urgent craniotomy to decompress the cranium .作者: kimikong0051 时间: 2010-5-19 20:23 回复 1#shenxiu2
回复一下，看看何题。作者: tangqiou2001 时间: 2010-8-1 12:16
CT确定脑出血部位，注意呼吸循环，降颅内压，急诊手术作者: xuxuebing 时间: 2010-10-9 11:44
A 72 year old male has been brought to your emergency room after being removed from a motor vehicle, which has been involved in a high speed collision. He is moaning, his eyes are closed and he withdraws to pain.
On transfer to the CT scanner his left pupil dilates.
1. "He is moaning, his eyes are closed and he withdraws to pain. " . This means that this patient maybe in subconciouness state. Though no record given, before his transfer to the CT room, his two pupil maybe in similar size. And "On transfer to the CT scanner his left pupil dilates", that means his condition developed very fast and ICP increased rapidly.
2. This is a quite urgent case. Mannital, laxis should be given immediately. At the same time tracheal intubation is very necessary in order to control the respiratory because potential respiratary depression or aspiration induced the increase of CO2 and hypoxia could be fatal.
3. Monitor his vital signs carefully and life support should be prepared. Be prepare for surgery. Informe the relatives anesthesia and operation related risks including aspiration, transfusion related risks.
4. Transfer to OR, and take craniotomy.作者: popqqcat 时间: 2010-10-9 12:19
Intubated with moderate hyperventilation
Consult nerologist
Check for possible lung contusion and blunt abdominal trauma