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Cerebro
-vascular Cardiac
16% disease
19%
Traffic death in Japan
18000
16765
16000
14000
12000 11227
10792 10792 10679
8000
6871
5744
6000
4000
2000
0
1965 1970 1975 1980 1985 1990 1995 2000 2005 2007
Case : 20 y.o. Male
CC: MVA
HPI: Crashed down on to the bank while driving
(more than 100km/hr). (+) Seat belt.
V/S on arrival: HR92/min, BP158/106mmHg,
R30/min, T36.8℃
GCS7 (E1V2M4), pupil (7.0, 4.5mm), LR(-) B/L
CT on arrival ①
CT on arrival ②
Other injuries
Pulmonary
Rt. clavicle fx. contusion B/L
Th5-7 fx.
CT 6 hrs later
Internal & external decompression
Core ICP
Temp
(℃)
Clinical course (mmHg)
38 Barbiturate coma 50
37
40
36
35 30
34
20
33
32 10
31
OR 0
1 2 3 4 5 6 7 8
Follow up CT
day2
day10
day26
TBI
GCS
4~8 9<
Exclusion criteria
Normothermia + -
Normothermia or
Operation + Normothermia
Active Mild
normothermia hypothermia Guidelines for traumatic brain injury
Showa University Hospital
Management of raised
intracranial pressure
Hyperventilation
Elevating head of bed
Hyperosmotic diuretics
Ventricular drainage
General anesthesia
Barbiturate coma
Hypothermia
Decompression surgery
ICP monitoring
GCS<8
Hypotension (SBP<90mmHg)
CT findings: Midline shift, loss of cistern
Barbiturate coma or hypothermia therapy
Hyperventilation
Temporizing measure for↓ICP.
Should be avoided during the first 24 hours
after injury when CBF is critically reduced.
SjO2 is recommended to monitor.
Elevating head of bed
15 to 30 degrees.
ICP reduction is reported 4.4 to 6.1mmHg at
30 degrees.
Mannitol and glycerol
Insufficient data to support the effectiveness.
Mannitol is effective for control of raised ICP.
Rebound phenomenon.
0.25~1g/kg q6h
We use glycerol more often traditionally.
Barbiturate coma
GCS<8
Uncontrollable ICP (>20mmHg)
With hypothermia therapy
Thiopental: 4~6mg/kg/h
Under mechanical ventilation
Adverse effects: Respiratory and circulatory
depression, hypokalemia
Hypothermia therapy
Under 70 y.o.
GCS≦8
Uncontrollable ICP (20-40mmHg) in spite of other therapies
Except diffuse cerebral swelling
Deep
circumflex
iliac
artery
Ascending
branch of
Superficial
lateral
epigastric
circumflex
artery
femoral
artery