Friday, August 13, 2010

Traumatic Intracerebral Hemorrhage

44 years old Malay gentle man

Alleged MVA today at Rawang
he was riding a MB before he hit a nearby old tyre by the roadside and skidded
he's wearing a fastened helmet

found unconscious and was brought alone by ambulance

Upon arrival to ED GCS was 5/15 ( E1V1M3)
pupil- rt 6mm lt 2mm fixed

patient was intubated-->noted loss of blood in the oral cavity
ryles tube inserted-->no blood/fluids come out

Pt is intubated and sedated
vital sign
BP 163/57 not on inotrops
pr 55
RR 15 on ventilator
swollen right supra-orbital with hematoma
pupil Rt cannot be asscess, Lt 2mm, non reactive

No oozing of blood from ear and nose
Noted dry blood over the nose and left ear Emergency CT scan brain:
ICB at Left frontal 5x4 cm over 4 cut with midline shift 0.6cm
no hydrochepalus, brain appears tight
Urgent craniectomy and evacuation of blood clot was performed.

Subsequently percutaneous tracheostomy was performed and weaned off ventilator
Currently CGS E4VTM5