Penetrating head trauma

[Jinx]

I haven't been able to find a straight answer on this but I'm sure there is. Patient has close range bullet wound to the temporal region and a blood pressure of 180/110. They are a young healthy male who should otherwise have a normal BP. I thought the cause of high BP might be a compensatory mechanism to maintain CPP (similar to IC haemorrhage) but given they don't have increasing ICP due to open wound and substantial blood loss I'm not sure and couldn't get a straight answer. Can anyone help me out?

 

[TransportJockey]

My thought would be the brain itself is herniating and swelling, thus causing the icp

 

[VFlutter]

My thought would be the brain itself is herniating and swelling, thus causing the icp

My thought as well. You need a fairly large burr hole to relieve the active pressure changes caused by that type of trauma.

 

[Jinx]

My thought would be the brain itself is herniating and swelling, thus causing the icp

My thought post incident is that clotting combined with swelling from such an insult causes ICP to rise?

http://emedicine.medscape.com/article/247664-overview#a0112
http://www.ncbi.nlm.nih.gov/pubmed/20568960

 

[Jinx]

My thought as well. You need a fairly large burr hole to relieve the active pressure changes caused by that type of trauma.

This was a small hole probably 1cm diameter. It also didn't exit, there was a bulging mass on the opposite side.

 

[Handsome Robb]

Also depending on what damage was done to the brain...and sympathetic response to pain. The whole fight or flight thing.

Lots of possibilities.

 

[Jawdavis]

So I'm confused here. Did he or did he not have an increased ICP? The original post says that he didn't.

 

[Carlos Danger]

So I'm confused here. Did he or did he not have an increased ICP? The original post says that he didn't.

I think the OP was simply assuming that the open wound would prevent increased ICP, and thus was wondering why the BP was elevated.

OP, as others have said, there probably was increased ICP due to swelling and bleeding in the cranial vault. The small bullet wound would probably not be nearly large enough to relieve pressure.

 

[mycrofft]

Brain tissue swells locally when exposed to extravascular blood. Maybe the insult from the wound and from the blood affected the part of the brain which raises bp in these cases?

 

[medicsb]

Burr-holes are placed to evacuate hematomas. In this case the bullet hole is likely not in a place to evacuate any hematoma, if there is one. A small hole will not relieve pressure from edema. With severe edema, you basically have to remove huge portion of the skull (e.g. the size of ones palm, or larger).

 

[Handsome Robb]

Burr-holes are placed to evacuate hematomas. In this case the bullet hole is likely not in a place to evacuate any hematoma, if there is one. A small hole will not relieve pressure from edema. With severe edema, you basically have to remove huge portion of the skull (e.g. the size of ones palm, or larger).

We transferred a guy with an open craniotomy a while back. My partner asked why he was wearing a skate helmet...

 

[mycrofft]

IN fact, sometimes they (used to?) do a trepan then actually remove gray matter if there's no better way to resolve swelling.

This is from my EMT text...