SAQ 157 – Paediatric Trauma – extradural haemorrhage and raised intracranial pressure

Question 9. extradural haemorrhage and raised intracranial pressure.

a. CT abnormalities

• Extradural haemorrhage, about 2.5 x 8.5 cm, left parietal.
• Midline shift about 1 cm.
• Sulcal effacement.
• Lateral ventricular effacement.
• Loss of grey-white matter differentiation.

b. ED steps to optimise ICP

• Intubate and control ventilation; consider hyperventilation.
• Sedation.
• Paralysis.
• Head up 30 degrees.
• Blood pressure control after discussion of targets with neurosurgery, using age-appropriate BP targets.
• IV mannitol.
• Seizure prophylaxis.
• Maintain normoxia, normothermia, and normoglycaemia.
• Avoid neck vein occlusion.

c. Initial ventilation settings

d. Information for parent

• He is critically unwell.
• Description of the injury and current condition.
• Treatment already given.
• Treatment required.
• Need for transfer to a neurosurgical centre.
• Guarded prognosis given the time frame and transfer required.