Module 4: Pediatric Head Injuries

Slide 1 - Learning ObjectivesSlide 2 - Pediatric Head Injury - EpidemiologySlide 3 - Intracranial Pressure - PhysiologySlide 4 - Raised ICP - Brain HerniationSlide 5 - CPP - PhysiologySlide 6 - Head Injury - PathophysiologySlide 7 - Respiratory Failure in Head-Injured ChildrenSlide 8 - Signs and Symptoms of Head InjurySlide 9 - Glasgow Coma Scale (GCS)Slide 10 - Glasgow Coma Scale (GCS) in Infants and ChildrenSlide 11 - Classification of Head Injury (HI) by GCSSlide 12 - AVPU Pediatric Response Scale for DisabilitySlide 13 - Common Lesions After Head InjurySlide 14 - Subdural HematomaSlide 15 - Epidural HematomaSlide 16 - Intracerebral HematomaSlide 17 - Management of Head InjurySlide 18 - Hypotension Associated with Poor OutcomeSlide 19 - Management of Raised ICPSlide 20 - HyperventilationSlide 21 - Ventilation - RecommendationSlide 22 - Fluid Therapy for Head InjurySlide 23 - Sedation, Analgesia and ParalysisSlide 24 - Use of Paralytic AgentsSlide 25 - Positioning Tips to Reduce ICPSlide 26 - Temperature RegulationSlide 27 - Management of SeizuresSlide 28 - AnticonvulsantsSlide 29 - Anticonvulsant ProphylaxisSlide 30 - Hyperosmolar TherapySlide 31 - Ventricular Catheter/ Lumbar Drain for Draining CSF to Reduce ICPSlide 32 - Decompressive CraniotomySlide 33 - Barbiturate ComaSlide 34 - Summary of ICP ManagementSlide 35 - Non-Accidental Injury (Shaken Baby Syndrome)Slide 36 - Shaken Baby SyndromeFamily Risk FactorsSlide 37 - Bruises - Abuse or Accident?Slide 38 - Evaluation of Suspected AbuseSlide 39 - Evaluation of Suspected AbuseSlide 40 - Child Abuse - The Physician's RoleSlide 41 - Review: Question 1Slide 42 - Review: Question 2Slide 43 - Review: Question 3Slide 44 - Review: Question 4Slide 45 - Review: Question 5Slide 46 - Acknowledgments of 46

CPP - Physiology

• Blood flow to the brain (cerebral blood flow) is governed by the difference between the mean arterial pressure (MAP) and intracranial pressure (ICP)
• This difference is the cerebral perfusion pressure (CPP)
  CPP = MAP - ICP
  (Normal ICP is 5-10 mm of Hg and MAP varies depending on child's age)
• Under conditions of head injury and raised ICP, blood flow to the brain can be maintained by "normalizing" the CPP. This can be achieved by elevating the MAP or decreasing the ICP or both. The optimal CPP in children is unknown and may depend on age. CPP < 40 mmHg is associated with poor outcome.

Module 4: Pediatric Head Injuries

Raised ICP - Brain Herniation

Head Injury - Pathophysiology