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Treatment of the veterinary head trauma patient | VETgirl Veterinary Continuing Education Videos

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In this VETgirl online veterinary continuing education video, we discuss how to manage head trauma in dogs and cats. Patients with head trauma should be immediately assessed for airway, breathing, circulation, and dysfunction (e.g., ABCD) status. The patient should be stabilized appropriately prior to managing the head trauma (e.g., focus on the ABC’s first!). Keep in mind that hypovolemic shock is often seen in the emergent or critically ill patient, which can further cause a depressed mentation, affecting the central nervous system (CNS) evaluation. An appropriate neurologic assessment should be made, including mentation, pupil sizes, pupillary light response, cranial nerves and reflexes prior to analgesia administration in the emergent patient.

In this video, a young, male neutered, stray cat was found hit by a car. The patient presented hypothermic, hypotensive, with dull mentation and profound anisocoria. As the patient was hypotensive, fluid therapy was initiated (e.g., such as a crystalloid bolus of 20 – 30 mL/kg over 15-20 minutes). Specifically with the head trauma patient, the use of hypertonic saline and/or synthetic colloids (e.g., Hetastarch, dextran-70) can also be considered. 7.2% hypertonic saline can be given at a dose of 5 mL/kg over 20-30 minutes to help improve cerebral blood pressure and flow, resulting in a decrease in intracranial pressure.

Although this cat initially improved after fluid resuscitation and hypertonic saline, there was a relapse of dull mentation and anisocoria within an hour. As this cat was volume resuscitated and normotensive, a dose of mannitol was given, resulting in significant improvement. Note that mannitol should not be given to a shocky, hypotensive patient, as it can deplete the intravascular volume through its osmotic diuretic effect.

Additional treatment of the head trauma patient includes reduction of intracranial pressure (ICP) by head elevation, oxygen therapy, fluid therapy, seizure control, judicious use of analagesics, and symptomatic supportive care. The patient should still be maintained on fluid therapy to help maintain perfusion and mean arterial pressure (as Cerebral Perfusion Pressure = Mean Arterial Pressure – Intracranial Pressure). Hyperoxygenation is recommended for any patient with head trauma to help minimize cerebral ischemia. NOTE: The use of nasal cannulas should be avoided, as they can induce sneezing, resulting in a severe and sudden elevation in intracranial pressure. Antiemetics, such as maropitant, can reduce nausea associated with head trauma, and further minimize the risk of aspiration pneumonia in mentally depressed patients. NOTE: The use of steroids is not recommended with head trauma patients.

Don’t give up too quickly on patients with head trauma. Many dogs and cats with head trauma can respond very well to treatment and can go on to live normal lives. Check out our VETgirl podcast on prognostic factors in dogs with head trauma for more information! Also, here’s a great VETgirl blog on traumatic brain injury also!

Check out our other great VETgirl videos for more life-saving tips.

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