Scribd
Upload
32 views18 pages

CGR 2024

The document describes the story of a 1-year-old boy who survived a severe traumatic brain injury after a car accident. He suffered a diffuse traumatic brain injury along with other injuries. An aggressive multidisciplinary rehabilitation approach was used including physiotherapy, nutrition support, and psycho-social stimulation. His condition gradually improved over time with regained functions but the prognosis remained guarded due to the severity of his brain injury.

Uploaded by

Ravikiran Suryanarayanamurthy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
32 views18 pages

CGR 2024

The document describes the story of a 1-year-old boy who survived a severe traumatic brain injury after a car accident. He suffered a diffuse traumatic brain injury along with other injuries. An aggressive multidisciplinary rehabilitation approach was used including physiotherapy, nutrition support, and psycho-social stimulation. His condition gradually improved over time with regained functions but the prognosis remained guarded due to the severity of his brain injury.

Uploaded by

Ravikiran Suryanarayanamurthy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 18

THE LITTLE WARRIOR

A STORY OF SURVIVAL
THE CALL
•1 year old boy Ivaan ( name changed )
•Involved in a catastrophic RTA
•Side-on collision of car and deep fall into a pit
•Child was on rear seat on mothers lap
•Found Gasping at scene
•With TBI and multiple other injuries and significant blood
loss
•Paramedics have intubated the child and stabilised at
local hospital and child was on the way to our hospital .
• Although we knew what to except , the reality was quite challenging.
• Child was on a ventilator on arrival with GCS : 5/15 , Pupils reactive .
• A head to toe examination and supportive scans from outside
revealed the following injuries

1. Acute traumatic diffuse SAH with IVH


2. SDH and multiple punctuate h’ge in right temporal lobes
3. Adrenal h’ge
4. Displaced commnuted fracture of humerus ( right side ).
5. Collapse consolidation of left lower lobe with lung parenchymal contusion.
ACT WISE ! ACT FAST !
• Aiwary : Child had a tube displacement on arrival requiring an
immediate reintubation
• Breathing : After reintubation , child was stable on ventilator with
acceptable blood gas . Sp02 98 % with
• Circulation : He had stable HR and BP , did not require any inotropic
support . There was no active bleeding on arrival . The external
injuries including scalp injury was sutured by 1st responders . His Hb
was normal .
• TBI stabilization done as per protocol
• A POCUS scan done at ER
• CT Brain with C spine done before shifting to PICU
• Baseline investigations sent (HB / PCV / Blood gas / Coagulation
profile , Chest xray )

• Child was stabilized in the Emergency room and shifted to PICU


IMMIDIATE MULTIDISCIPLINARY
TEAM APPROACH

• Neurosurgery Team – CT showed ….. And there was no acute ative


intervention required .
• Orthopedics Team –
• Anesthesia Team – Airway , IV access and Pain management
• Radiologists
PICU
• MRI was of utmost priority
as the child continued to
have poor GCS despite not
being on any sedations . A
severe DAI was suspected .
•
MRI IMAGES AND GRADING OF
INJURY
• We were very concerned about the prognosis of this boy.
• The best case scenario and worst case scenario was still
unclear .
• I was a part of the first members of the medical team to talk
to the family about the extent of his injuries.
• Since the father was not at the accident scene, We had to
tell them what had happened based on the report we had
received . Explaining the MRI finding to the father , he
immediately put his head into his hands and began to cry. I
remember Dr Rajath telling him that his survival by itself is a
miracle and his prognosis is very concerning. It would be a
miracle for him to survive without any long-term medical
impairments
• Seizures were managed with antiepileptics. EEG done showed diffuse
slow wave discharges with no epileptiform discharges .

• GCS Gradually improved over 48 hrs .

• Motor movements were restricted . Power 2/5 of all 4 limbs in the


initial 1 week . He had no balance of trunk .

• He could not swallow .

• He had lost head control .

• He lost eye contact

•
• Early aggressive physiotherapy was the need of the hour .

• Planned early tracheostomy and nutritional rehabilitation was


priorited .

• It was a fine balance of physiotherapy , nutrition ,


counselling sessions , excellent team work and
multidisciplinary approach that showed the first signs of
recovery .

• Everyday started to become a milestone from then on


• Child was started on aggressive physiotherapy along with
pyscho-socio-sensory stimulation including tactile,
proprioceptive, kinesthetic, auditory, visual and vestibular
stimulus

• He gained power
• His swallowing improved with oro pharyngeal exercises
• He slowing started maintain eye contact
• Recognised his father
• Started to smile
• Was able to sit without support
CHALLENGES FACED
• Poor GCS on arrival with ?Hypoxia (Gasping) at the scene of event .
• Poor motor response
• Severe TBI with midline shift (grade 3) on MRI making long term
prognosis guarded
• Nutritonal rehabilitation as swallowing capacity was significantly
impaired making aspiration chances high
• Initially few days was not maintaining eye contact
• Extensive Multidisciplinary team work with balance
PSYCHO-THERAPIST OPHTHALMOLOGIST

PAEDIATRICIAN ENT
MULTI-
DISCIPLINARY
ORTHOPAEDICIAN APPROACH ... RADIOLOGIST

NEUROSx
PHYSIOTHERAPIST
PAEDIATRIC Sx
Tough time
Stormy course
Anxiety, Distress

Supportive treatment

Repeated Communication/ counselling ,


Reassurance
Empathy
Patient vigil
s s io n
e r m i
i t h p
W
s s io n
e r m i
i t h p
W

You might also like