الفهرس 
ANATOMY AND PHYSIOLOGYOnly 14 pages are availabe for public view
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Abstract
The brain is composed of 2 cerebral hemispheres each has 4
lobes, basal ganglia, diencephalon, brain stem, cranial nerves,
and the cerebellum. Covered with 3 layers of meninges (the
dura, the arachnoid, and the pia). The brain has 4 ventricles
filled with the cerebrospinal fluid. The brain tissue is separated
from the blood milieu by the blood brain barrier. The brain is
supplied by the internal carotid and the vertebral arteries and
drained into the internal jugular veins. Due to the high
metabolic rate, the brain receives 15% of the cardiac output,
consumes 20% of total body oxygen, and 25% of total body
glucose utilization.
Traumatic Brain Injury is a major cause of death and disability
worldwide, especially in children and young adults below 40
years. Males sustain traumatic brain injuries more frequently
than do females. Causes include falls, vehicle accidents, and
violence.
Traumatic Brain injuries can be classified as primary injuries
such as (brain concussion, cerebral contusions, intracranial
hematomas and diffuse axonal injury) which occur at the time
of impact. Secondary brain injuries are inflammatory process
due to hypoxia and ischemia leading to a cascade of cellular
and biochemical changes leading to cell damage. This will lead
to increase the intracranial pressure and cerebral edema. Other
systemic insults could happen include (hypotension, hypoxia,
hyperpyrexia, anemia and seizures). Evaluation of head trauma patient includes history taking, physical examination,
assessment of conscious level, pupillary examination and motor
examination. Head trauma may be complicated with seizures,
CNS and systemic infections, venous thromboembolism,
disseminated intravascular coagulation, hydrocephalus, cardiac
dysfunction and water and electrolytes imbalance. Imaging
investigations are CT brain, cerebral angiography, transcranial
doppler ultrasonography and magnetic resonance imaging.
Management of TBI Patient in ICU aims to control ICP,
Reducing brain swelling and optimizing systemic blood pressure.
Mechanical interventions for the raised ICP include surgery for
evacuation of hematomas, CSF drainage, and decompressive
craniectomy. Medical strategies include Hyperosmolar therapy
with mannitol or hypertonic saline solutions, analgesia, sedation
and paralysis, seizures prophylaxis, barbiturate coma,
hyperventilation and prophylactic hypothermia. General ICU
management of TBI patient include body position and
physiotherapy, management of shock, mechanical ventilation,
nutritional support, glycemic control, stress ulcer prophylaxis,
venous thromboembolic prophylaxis and Antibiotics.