Page 783 - Clinical Small Animal Internal Medicine

69 Central Nervous System Trauma 751

Table 69.3 Monitoring parameters for the cat and dog following head trauma
VetBooks.ir Monitoring parameters Suggested goal Suggested treatment

Neurologic examination MGCS >15 Ensure head elevation (30°)
Ensure all points below are addressed
Consider mannitol (see below)
Consider surgery (see text)
Blood pressure MAP 80–120 mmHg Adjust fluid therapy
Pressor support (dopamine 2–10 μg/kg/min)
Blood gases PaO 2 >/=90 mmHg Oxygen supplementation
PaCO 2 <35–40 mmHg Consider active ventilation
Pulse oximetry (SpO 2 ) SpO 2 >/=95% Oxygen supplementation
Consider active ventilation
Heart rate and rhythm Avoid tachy‐ and bradycardias Adjust fluid therapy
Avoid arrhythmias Treat for pain
Address ICP
Treat arrhythmias specifically
Central venous pressure 5–12 cmH 2 O Adjust fluid therapy
Respiratory rate and rhythm 10–25/min Ventilate if necessary
Body temperature 37–38.5 °C Passive warming or cooling
NSAIDs if hyperthermic
Electrolytes See individual laboratory normal values Adjust fluid therapy
Blood glucose 4–6 mmol/L Adjust fluid therapy
Consider dextrose administration
Intracranial pressure 5–12 mmHg As for MGCS abnormalities
ICP, intracranial pressure; MAP, mean arterial pressure; MGCS, Modified Glasgow Coma Scale; NSAID, nonsteroidal antiinflammatory drug.

contusions, pneumothorax, and abdominal injuries. Without any extracranial lesions, the prognosis associ-
Pulmonary contusions are common following trauma ated with head trauma is dependent on the location and
and may not be most severe until 24 hours after injury. severity of the parenchymal lesions.
Trauma can also result in injury to abdominal organs. The assessment should include evaluation of state of
The abdomen should be evaluated with CT or radiogra- consciousness, motor function and reflexes, pupil size
phy and ultrasonography for the presence of free fluid, and responsiveness, position and movement of the
blood, or urine, which may require additional therapy. eyes, and breathing pattern. The evaluation of pupil and
Radiographs of the cervical vertebrae should also be con- eye function is the most accurate manner in which
sidered as head trauma can often be accompanied by brainstem function can be assessed and this is the most
fractures and luxations of these bones. important part of the examination prognostically. A
scoring system has been developed in veterinary patients
Neurologic Assessment to provide an objective assessment and allow for rational
Neurologic assessment should be undertaken on any diagnostic and treatment decisions.
animal which has experienced a trauma. Assessment of
neurologic status in a patient after head trauma should Modified Glasgow Coma Scale
initially be performed every 30–60 minutes. Frequent The Glasgow Coma Scale (GCS) is used in human medi-
assessment allows for monitoring the efficacy of treat- cine to assess head trauma patients by evaluating eye,
ment and early recognition of deteriorating status. verbal, and motor responses. This scale has been modi-
Primarily, neurologic evaluation of the patient serves to fied and applied to veterinary patients. The Modified
determine whether there are deficits suggesting struc- Glasgow Coma Scale (MGCS) evaluates motor activity,
tural neurologic lesions, where the lesions are located brainstem reflexes, and level of consciousness in veteri-
(i.e., at least intracranial, spinal, and peripheral nerve), nary patients, enabling initial and serial monitoring
and the severity of the lesion(s). Detection of a spinal following injury. The three categories evaluated using
and/or peripheral nerve (e.g., brachial plexus) lesion can the MGCS provide objective standards for scoring a
affect the prognosis of any patient with head trauma. patient between 1 and 6, with lower scores assigned to