TAILIEUCHUNG - Critical Care Obstetrics part 52

Critical Care Obstetrics part 52 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Trauma in Pregnancy Head trauma Approximately 50 of all trauma deaths are associated with head injury. Over 60 of motor vehicle- associated trauma deaths occur as a result of head trauma 6 . In a recent review of pregnant trauma deaths in Cook County Illinois approximately 10 of maternal trauma deaths were directly due to head injury 112 . Several aspects of cranial and cerebral physiology and pathophysiology are very important in head trauma victims. The brain is one of the most carefully protected organs of the body the calvarium and cerebrospinal fluid cushion the brain from minor trauma. However in severe trauma these two otherwise protective features may contribute to or precipitate brain injury. The brain has poor tolerance of diminished perfusion with little or no metabolic reserve in brain tissues. Global cerebral oxygen consumption of at least 100g min must be maintained to prevent injury. Oxygen delivery to the brain is determined by blood pressure blood oxygen content blood flow distribution and relative perfusion pressure. Because the closed space of the calvarium is occupied by blood cerebrospinal fluid and brain volume intracranial pressure is a function of all three components referred to as the Monro-Kellie doctrine. Cerebral edema results in increased brain volume thereby producing elevated intracranial pressure. Traumatic collections of blood in the cranial vault will similarly increase intracranial pressure. Often both of these mechanisms are present in the head trauma victim 113 114 . Cerebral autoregulation in traumatic injury Cerebral autoregulation is normally maintained over a wide range of blood pressures. Extremes of blood pressure such as hypotension found in the multiple trauma victim taxes the brain s ability to autoregulate. When coupled with cerebral edema and or intracranial bleeding hypotension further aggravates the inability of the brain to autoregulate. When the injured brain loses its ability to autoregulate .

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