By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi
Global specialists in ailments of the adrenal glands current new medical info and useful guidance for surgeons, citizens, endocrinologists and practicing physicians. The e-book covers all features of adrenal gland ailments in nice aspect. contains approx. 2 hundred illustrations akin to radiographs, CTMRI photographs, graphs and microscopic pathological slides, and so forth. a number of tables and colour illustrations of surgical ideas with emphasis at the laparoscopic technique are incorporated.
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Since the various types of head trauma and intracranial haematomas and their treatment have already been described in the chapter on head injuries, this section will focus on the approach to the head-injured child; identify subtypes unique to children; and emphasise some of the differences from adults. In assessing the head-injured child, the first important step is to try to determine the risk of intracranial haemorrhage. A good history and physical examination are mandatory. e. low-risk, medium-risk or high-risk (Table 3), then the management algorithm becomes logical (Annex 2).
Clinical features are usually subtle, and have been ignored or missed for some time. There may be developmental delays such as slowness to talk or walk. However in children with significantly raised intracranial pressure, the fontanelle will be palpably tense, and there will be papilloedema (although the absence of papilloedema does not exclude raised intracranial pressures or ICP) with “sunset” eyes (Fig. 3). The emergency presentation of hydrocephalus with altered consciousness commonly occurs in the following situations: (1) Posterior fossa tumours This will be discussed further in the section on brain tumours.
Suspicion of neurological deterioration not due to extra-cranial explanations. Acute Management of Head Injuries 17 Indications for mannitol1 Mannitol is a high-molecular-weight sugar that can be administered to lower the ICP. By exerting an osmotic effect, extracellular fluid is removed from the brain. Mannitol is indicated if there is evidence of transtentorial herniation or progressive neurological deterioration. The signs of transtentorial herniation include unilateral or bilateral pupillary dilatation, asymmetric pupillary reactivity, and abnormal motor posturing (decorticate, decerebrate or no movement).
Acute Surgical Management by Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi