Here is Tom’s talk on the significance and prognostic implications of fixed dilated pupils in patients with intracranial haemorrhage. This talk was predominantly based around a recent paper : Scotter et al, Prognosis of patients with fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis, Emerg Med J, 2014. However, this was used as a nidus for a discussion on considerations in deciding on aggressive versus conservative management of this patient group.
Resources:
- Types of Brain Herniation:
- Causes of a single fixed dilated pupil from LITFL
- Cliff Reid’s (Resus.me) take on the above systematic review and meta-analysis – “Bilateral fixed dilated pupils? Operate if extradural!”
- Traumatic Brain Injury (TBI) Prognosis from LITFL:
- CRASH head injury prognosis calculator
- generated from: Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008; 336
- IMPACT head injury prognosis calculator
- Based on extensive prognostic analysis the IMPACT investigators have developed prognostic models for predicting 6 month outcome in adult patients with moderate to severe head injury (Glasgow Coma Scale <=12) on admission
- CRASH head injury prognosis calculator
