Acute head trauma

Acute head injuries A study evaluating the effect of IV valproate in the prevention of posttraumatic seizures in patients with acute head injuries found a higher incidence of death in valproate treatment groups compared with the IV phenytoin treatment group. Until further information is available, it seems prudent not to use valproate sodium injection in patients with acute head trauma for the prophylaxis of posttraumatic seizures. 

The nitrates are used cautiously in patients witii severe hepatic or renal disease, severe head trauma, acute myocardial infarction (MI), hypotiiyroidism, and during pregnancy (Pregnancy Category C, except for amyl nitrate) or lactation. 

Chest pain that is not relieved by two or three tablets within 30 minutes may be due to an acute myocardial infarction. In addition, nitrate administration may result in an increase in intracranial pressure, and therefore, these drugs should be used cautiously in patients with cerebral bleeding and head trauma. 

Clifton G. L., Choi S. C., Miller E. R., et al. (2001) Intercenter variance in clinical trials of head trauma—experience of the National Acute Brain Injury Study Hypothermia. J. Neurosurg. 95,751-755. 

Neurology recognizes that relatively minor head trauma—even without the delirium, loss of consciousness, and seizures associated with ECT— frequently produces chronic mental dysfunction and personality deterioration (Bernat et al., 1987). If a woman came to an emergency room in a confusional state from an accidental electrical shock to the head, perhaps from a short circuit in her kitchen, she would be treated as an acute medical emergency. If the electrical trauma had caused a convulsion, she might be placed on anticonvulsants to prevent a recurrence of seizures. If she developed a headache, stiff neck, and nausea—a triad of symptoms typical of post-ECT patients—she would probably be admitted for observation to the intensive care unit. Yet ECT delivers the same electrical closed-head injury, repeated several times a week, as an alleged means of improving mental function. ECT is electrically induced closed-head injury. 

Mannitol, the most commonly employed osmotic diuretic, is a large polysaccharide molecule. It is often selected for use in the prophylaxis or treatment of oliguric ARF. It is not absorbed from the gastrointestinal tract and, therefore, is only administered i.v. with its elimination dependent on the GFR (within 30 to 60 min with normal renal function). Mannitol is distributed within the plasma and extracellular fluid spaces and produces an increase in the serum osmolality and expansion of the circulating volume. It is not generally used for the treatment of edema because any mannitol retained in the extracellular fluid can promote further edema formation. Furthermore, acute plasma volume expansion may challenge individuals with poor cardiac contractility and can precipitate pulmonary edema. Mannitol is commonly administered for the treatment of cerebral edema consequent to head trauma or to hypoxic-ischemic encephalopathy in neonatal foals. Because mannitol promotes water excretion, hypernatremia is a potential complication in patients that do not have free access to water (Martinez-Maldonado Cordova 1990, Wilcox 1991). 

The acute stroke evaluation should be made available for all patients with a sndden-onset nenrologic deficit, the basis of the stroke syndrome. Though focal neurologic deficits are common in stroke patients, they may not be present in some conditions, for example subarachnoid hemorrhage, or they may reqnire specific sfroke expertise to be elicited, for example top of basilar artery embolus. The most difficult diagnostic problems usually occur in patients with an altered level of consciousness, especially if there are other potential causes of encephalopathy, such as alcohol intoxication, systemic illness, head trauma, etc. There is tremendous variation in the presentation of acute stroke patients. This variation depends on whether the stroke... 

Obtain medical history. Assess airway, breathing, and circulation (blood pressure). Physical examination for signs of head trauma, seizure, bleeding, aortic dissection, acute Ml. Evaluate EKG for evidence of acute Ml, dysrhythmia. 

Although some steps were taking place in the United Kingdom to reduce accidents -for instance, the 1855 Factory Act provided for surgeons to investigate workplace accidents - the principal interest in the nineteerrth century was in occupational disease, perhaps because the inspection system was headed by doctors. A scientific approach to the causes of accidents, and the acute physical trauma some produced, really started in the USA. 

Use cautiously in patients with cardiovascular disease especially during the acute recovery phase of MI. Possible dose adjustment in patients with hepatic or renal dysfunctions, seizure disorders, head trauma, alcoholism, schizophrenia, or bipolar manic depression. Use with caution in patients with drug abuse history. 

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