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Pediatric Head Trauma Medication
- Author: Michael J Verive, MD, FAAP; Chief Editor: Timothy E Corden, MD more...
Medication Summary
Medical therapy is directed at controlling intracranial pressure (ICP) through the administration of sedatives and neuromuscular blockers, diuretics, and anticonvulsants.
Neuromuscular Blockers, Nondepolarizing
Class Summary
Nondepolarizing neuromuscular blockers are used in combination with a sedative as part of the rapid-sequence intubation process or as a means of controlling ICP.
Vecuronium is used to facilitate endotracheal intubation and provide neuromuscular relaxation during intubation and mechanical ventilation. It is given as an adjunct to a sedative or hypnotic agent.
Anticonvulsants, Barbiturates
Class Summary
Barbiturates are used as adjuncts for intubation in patients with head trauma and in the management of elevated ICP. They may also be used as anticonvulsants. Their use must be accompanied by appropriate hemodynamic monitoring, as they may cause profound hypotension and apnea/hypopnea.
Thiopental is the drug of choice for endotracheal intubation of patients with head injury. It also decreases the ICP. Thiopental facilitates transmission of impulses from the thalamus to the cortex, resulting in an imbalance in central inhibitory and facilitative mechanisms.
Pentobarbital (Nembutal)
Pentobarbital is a short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties. It may be used in high dosages to induce barbiturate coma for treatment of refractory increased ICP.
Phenobarbital is used for seizure control in patients with head trauma.
Anxiolytics, Benzodiazepines
Class Summary
Benzodiazepines may be used to obtain immediate control of seizure activity or as adjuncts to narcotics and neuromuscular blockers for control of ICP. Prolonged use of these drugs may alter neurologic examination findings.
Midazolam is a short-acting benzodiazepine with a rapid onset of action. It is useful in treating increased ICP.
Lorazepam (Ativan)
Lorazepam is a long-acting benzodiazepine used as an anticonvulsant for the immediate control of seizure activity.
Class Summary
Diuretics may have a beneficial effect in lowering ICP by decreasing cerebrospinal fluid (CSF) production, preferentially excreting water over solute, and decreasing blood viscosity, with subsequent improvement of cerebral blood flow (CBF).
Furosemide (Lasix)
Furosemide is a loop diuretic that helps decrease ICP via 2 separate mechanisms. One mechanism influences CSF formation by affecting sodium-water movement across the blood-brain barrier; the other mechanism is the preferential excretion of water over solute in the distal tubule.
Mannitol (Osmitrol)
Mannitol is an osmotic diuretic that lowers blood viscosity and produces cerebral vasoconstriction with normal CBF. A decrease in ICP occurs subsequent to a decrease in cerebral blood volume (CBV).
Class Summary
These agents may be used to control ICP by decreasing the effect of noxious stimuli (eg, endotracheal intubation, suctioning, pain from traumatic injury itself). Although lidocaine has been widely used in the past to blunt transient increases in ICP during endotracheal intubation, there is no high-level evidence to support its continued use for this purpose.[36]
Fentanyl (Sublimaze)
Fentanyl is a potent synthetic opioid with a rapid onset and short duration of action. Although an opioid, fentanyl produces only mild sedation at usual doses, and it is commonly used in combination with a benzodiazepine.
Propofol (Diprivan)
Propofol is an oil-soluble hypnotic agent with a rapid onset and short duration of action. Because propofol has limited anesthetic action, it is usually used with an opioid such as fentanyl for painful procedures. Propofol use is associated with hypotension, bradycardia, and apnea, especially when boluses are given for induction of anesthesia. Because of its short duration of action, propofol infusions may be discontinued briefly to allow neurologic testing, and then restarted (with or without bolus) to resume sedation.
Class Summary
Anticonvulsants are recommended as a prophylactic measure for patients at increased risk for seizure activity after head trauma. No proof exists of a beneficial effect in seizure prevention more than 1 week after head trauma. These agents are also used for immediate control of seizures.
Phenytoin (Dilantin, Phenytek)
Phenytoin may act in the motor cortex, where it may inhibit the spread of seizure activity. It may also inhibit the activity of the brainstem centers responsible for the tonic phase of grand mal seizures. Phenytoin is preferred to phenobarbital for controlling seizures because it does not cause as much central nervous system (CNS) depression.
Fosphenytoin (Cerebyx, ProEpanutin)
Fosphenytoin is a diphosphate ester salt of phenytoin that acts as a water-soluble pro-drug of phenytoin. Following administration, plasma esterases convert fosphenytoin to phosphate, formaldehyde, and phenytoin. Phenytoin, in turn, stabilizes neuronal membranes and decreases seizure activity.
To avoid the need to perform molecular weight–based adjustments when converting between fosphenytoin and phenytoin sodium doses, express dose as phenytoin sodium equivalents (PE). Although fosphenytoin can be administered IV and IM, the IV route is the route of choice and should be used in emergency situations.
Trenchs V, Curcoy AI, Castillo M, et al. Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?. Eur J Emerg Med. 2009 Jun. 16(3):150-2. [Medline].
Ringl H, Schernthaner R, Philipp MO, et al. Three-dimensional fracture visualisation of multidetector CT of the skull base in trauma patients: comparison of three reconstruction algorithms. Eur Radiol. 2009 May 14. [Medline].
Boggs W. Point-of-care ultrasound finds skull fractures in children. Medscape Medical News. May 24, 2013. Available at http://www.medscape.com/viewarticle/804784. Accessed: June 3, 2013.
Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW. Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children. Pediatrics. 2013 Jun. 131(6):e1757-64. [Medline].
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Guilliams K, Wainwright MS. Pathophysiology and management of moderate and severe traumatic brain injury in children. J Child Neurol. 2016 Jan. 31 (1):35-45. [Medline].
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Hymel KP, Stoiko MA, Herman BE, et al. Head injury depth as an indicator of causes and mechanisms. Pediatrics. 2010 Apr. 125(4):712-20. [Medline].
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Mackerle Z, Gal P. Unusual penetrating head injury in children: personal experience and review of the literature. Childs Nerv Syst. 2009 May 19. [Medline].
Haider AH, Crompton JG, Oyetunji T, Risucci D, DiRusso S, Basdag H, et al. Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies. J Pediatr Surg. 2011 Aug. 46(8):1557-63. [Medline].
Shein SL, Bell MJ, Kochanek PM, Tyler-Kabara EC, Wisniewski SR, Feldman K, et al. Risk Factors for Mortality in Children with Abusive Head Trauma. J Pediatr. 2012 May 11. [Medline].
Kapapa T, Pfister U, Konig K, et al. Head trauma in children, part 3: clinical and psychosocial outcome after head trauma in children. J Child Neurol. 2010 Apr. 25(4):409-22. [Medline].
Ley EJ, Srour MK, Clond MA, et al. Diabetic patients with traumatic brain injury: insulin deficiency is associated with increased mortality. J Trauma. 2011 May. 70(5):1141-4. [Medline].
Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings--part 1. J Neuroimaging. 2012 Apr. 22(2):e1-e17. [Medline].
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Rangarajan N, Kamalakkannan SB, Hasija V, et al. Finite element model of ocular injury in abusive head trauma. J AAPOS. 2009 May 4. [Medline].
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Manzano S, Holzinger IB, Kellenberger CJ, et al. Diagnostic performance of S100B protein serum measurement in detecting intracranial injury in children with mild head trauma. Emerg Med J. 2016 Jan. 33 (1):42-6. [Medline].
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[Guideline] Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May. 135 (5):e1337-54. [Medline].
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|≥1 Year
|0-1 Year
|Opens eyes spontaneously
|Opens eyes spontaneously
|Opens eyes to a verbal command
|Opens eyes to a shout
|Opens eyes in response to pain
|Opens eyes in response to pain
|No response
|No response
|≥1 Year
|0-1 Year
|Obeys command
|Localizes pain
|Localizes pain
|Flexion withdrawal
|Flexion withdrawal
|Flexion abnormal (decorticate)
|Flexion abnormal (decorticate)
|Extension (decerebrate)
|Extension (decerebrate)
|No response
|No response
|> 5 Years
|2-5 Years
|0-2 Years
|Oriented and able to converse
|Uses appropriate words
|Cries appropriately
|Disoriented and able to converse
|Uses inappropriate words
|Uses inappropriate words
|Cries and/or screams
|Cries and/or screams inappropriately
|Makes incomprehensible sounds
|No response
|No response
|No response


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subset: commoncrawl


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[Ongoing Poll] K-Pop Group that Expanded Global Influence the Most in First Half of 2012: f(x) No.1 Followed by Super Junior, TVXQ, 2NE1, and Girls' Generation (SNSD)
By Staff Writer | June 20, 2012 09:58 PM EDT
KpopStarz is currently the second part of the poll to select the male & female group that expanded their influence the most globally during the first half of 2012.
The poll is taking place with active participations from avid K-Pop fans and readers worldwide. f(x) is leading with 11.2% followed closely by Super Junior at 10.5% also TVXQ with 10.4%, fourth place is 2NE1 with 8.7% and fifth place is taken by Girls' Generation at 7.9%.
The poll began on midnight of June 17 will conclude on June 23. Click here to vote for K-Pop group that expanded their global influence the most in the first half of 2012.
© Copyright 2016 KpopStarz.com. All Rights Reserved.
Tagged : f(x), Super Junior, TVXQ, 2NE1, Girls Generation, SNSD
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- Record Label: Astralwerks
- Release Date: Jun 26, 2001
- Summary: The follow-up to the Jaxx' critically-acclaimed 1999 debut album, 'Remedy,' 'Rooty' finds the British house duo adding to the party vibe with elements of pop and R&B thrown into the mix. The lead single is "Romeo."
- Record Label: Astralwerks
- Genre(s): Dance, Electronic, House
- More Details and Credits »
Score distribution:
Positive: 20 out of 23
Mixed: 2 out of 23
Negative: 1 out of 23
Rooty is the second straight triumph from a pair of producer/DJs who look set to carry the torch for dancefloor electronica in the years to come.
But sound for sound's sake isn't what makes the disc work; it's the recurring female singers, who add forlorn soul to the rhythms.
The nerve of it all is breathtaking. Turbo-beats poke up a gospel-jazz revivalist meeting, a mariachi band wanders into the hazy disco sashay of 'Broken Dreams', a Gary Numan sample gets bludgeoned to credibility in the Van Helden-esque pogo of 'Where's Your Head At?'.
It's no different from the formula that made Fatboy Slim and the Chemical Bores such big hits, but something's different this time around: Basement Jaxx have soul.
On Rooty, Basement Jaxx refines the ambitious but untidy sprawl of its debut into a carnivalesque mix of two-step, house, funk, and disco with a modern take on George Clinton's late-seventies mission of "rescuing dance music from the blahs."
In pursuing the anarchic, joyous mash-up of their debut Remedy to its twisted conclusion, Basement Jaxx find themselves in androgynous, genre-bending territory that is Prince-ly in spirit even when it isn't in sound.
A few fatal flaws eclipse all of Rooty's abundant qualities. Basement Jaxx have taken kitsch a few steps too far.
Score distribution:
Positive: 4 out of 4
Mixed: 0 out of 4
Negative: 0 out of 4
BillyBoyMay 18, 2006Where's your head at is a timeless classic. I could listen to that song alone over and over. But the rest of the album is great as well.
MattFeb 1, 2004Best dance album of the year. You could easily dance yourself to death.
JasonB.Jul 30, 2001Very fun to listen to and makes you want to dance in your car.
Awards & Rankings
|Lemonade - Beyoncé
|1971-1981 [Box Set] - Cluster
|You Will Never Be One of Us - NAILS
|Coloring Book [Mixtape] - Chance the Rapper
|Centres - Ian William Craig
|Close to the Noise Floor: Formative UK Electronica 1975-1984 [Box Set] - Various Artists
|Vile Child - Milk Teeth
|A Moon Shaped Pool - Radiohead
|Love & Hate - Michael Kiwanuka
|Upland Stories - Robbie Fulks
|Puberty 2 - Mitski
|Hollowed - Ital Tek
|A Sailor's Guide to Earth - Sturgill Simpson
|Strange Country - Kacy & Clayton
|This Is Where I Live - William Bell
|Nerissimo - Teho Teardo
|Misadventures - Pierce the Veil
|untitled unmastered. - Kendrick Lamar
|Stranger to Stranger - Paul Simon
|Midwest Farmer's Daughter - Margo Price


text:
Slain officer's vigil includes policing critique
"Grave need" to bridge the animosity gap, says activist leader
Dave Rice 11:35 a.m., July 30
Posted July 10, 2013
The author meets a West African witch doctor.
In my long-range travels I have learned two great lessons: 1) the people most removed from the modern world not only think differently than I do but are far more logical, and 2) Western-style capitalism ...
Dave Rice 11:35 a.m., July 30
Matthew Craig Burke 10:04 a.m., July 30
Jeff Smith 9 a.m., July 30
Walter Mencken 8 a.m., July 30
Ian Anderson 6 p.m., July 29
Garrett Harris 4 p.m., July 29
Ken Harrison 2:30 p.m., July 29
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