The MGCS can predict prognosis, with lower scores carrying a poorer prognosis. Both primary and secondary brain injuries occur as a result of head trauma, resulting in immediate and delayed effects. The prognosis for head trauma patients is variable depending on the severity of the injury and comorbidities. Oral medications, food, and water should be withheld until the patient is able to swallow on their own. During recovery, nursing care is essential to prevent secondary problems such as pressure sores, aspiration pneumonia, urine retention, and corneal ulceration. In most cases, giving time for the patient to recover is a core part of treatment. Powers feels that “these may or may not be helpful and are clinician’s preference when as a treatment for head injury.” Additional treatments including controlled hypothermia and administration of other medications have been discussed in the literature, but results are currently equivocal. Powers reminds veterinarians that “by preventing the hypovolemia and hypoxemia secondary to shock, often the brain function will improve without necessarily treating the brain trauma directly.”Īdministration of steroids is no longer recommended as a first-line therapy as there is limited clinical evidence in human medicine to support their use.

More specific treatment goals include seizure management, controlling increased intracranial pressure, maintaining carbon dioxide levels, and maintaining cerebral perfusion pressure. Pain control is also essential for head trauma patients and pure mu opioids are recommended as they can be easily reversed in the case of declining neurologic or cardiovascular status. Basic stabilization measures, including placement of a large gauge IV catheter, delivery of intravenous fluids, and supplemental oxygen delivery can improve mentation status significantly in some patients. Treatment goals for head trauma patients will vary by the patients’ status at presentation and comorbidities. CT scans are the preferred imaging modality for assessment of skull fractures as radiographs are difficult to interpret and may be inconclusive. If imagining is deemed necessary, the patient should be cardiovascularly stabilized prior to anesthesia. MRI is the imaging modality of choice for brain imaging, but unless the patient is declining, general anesthesia should be avoided. Noninvasive blood pressure, preferably with a Doppler, blood gas analysis, and imaging needed to assess other wounds (such as chest radiographs and ultrasonography) should also be performed. Jugular venipuncture should be avoided when collecting samples as compression of this vein can increase intracranial pressure. Administration of a pure mu opioid can help to address pain and facilitate handling when obtaining diagnostics.Ī complete blood count (CBC), serum biochemical profile, and urinalysis should be assessed in these patients. It is essential when handling head trauma patients to minimize stress and prevent the patient from struggling however, sedation and general anesthesia are contraindicated in most head trauma cases. In addition to asking about comorbidities and medications, history taking should include specific questions to assess when the trauma occurred and assess for any loss of consciousness, mentation, and seizure activity following the trauma. Use of the Modified Glasgow Coma Score (MGCS) can provide a quantitative evaluation that allows for objective reassessment overtime. Clinicians should assess the pupillary light reflex (PLR), pupil symmetry, ambulatory status, and mentation status of the patient.

Ideally the neurological evaluation should be performed prior to administration of medication. Powers reminds clinicians that many of these patients present in shock, and their mentation may improve significantly with the treatment of shock alone. Airway, breathing, and circulatory status should be stabilized while minimizing movement of the patient. Patients presenting with head trauma should be triaged like any emergency patient. During a session at the Fetch dvm360 ® Kansas City conference, Danielle Powers, DVM, DACVIM (Neurology), of the Animal Medical and Surgical Center in Scottsdale, Arizona discussed management of head trauma for veterinary patients from initial presentation through recovery. There are several unique considerations for patients that have sustained head trauma at presentation and during their hospital stay. Head trauma in veterinary patients is an emergency presentation that commonly occurs after a motor vehicle accident or other blunt or penetrating trauma.

Signs of head trauma in small dogs