Head trauma in dogs and cats is a common clinical emergency that requires immediate attention, whether it occurs in isolation or with concurrent systemic trauma. During the recent webinar, "Head Trauma Doesn’t Have to be a Headache," led by the renowned Dr. Simon R. Platt, participants were given an in-depth exploration of how to effectively manage these critical cases. Dr. Platt, with his extensive experience in veterinary neurology, guided attendees through practical approaches for examining and treating head trauma in pets, providing vital insights for clinicians. 

Understanding Head Trauma 

Dr. Platt began the session by explaining the pathophysiology of traumatic brain injury (TBI), highlighting the importance of maintaining intracranial pressure (ICP). An increase in ICP can lead to a dangerous reduction in cerebral perfusion pressure (CPP), restricting oxygen delivery to the brain, which can result in further damage. In severe cases, this can cause cerebral herniation, a life-threatening condition. 

He detailed the two types of cerebral herniation and stressed the urgency of evaluating and treating patients with head trauma as swiftly as possible to mitigate secondary brain damage. 

Examination and Evaluation 

The practical examination of head trauma patients involves a systematic approach. Dr. Platt emphasised that clinicians must quickly assess: 

• Physical examination: Focusing on ABCs (Airway, Breathing, Circulation) 

• Thoracic evaluation to rule out concurrent trauma 

• Blood pressure, PCV/TP/BUN, and electrolytes 

• Oxygenation levels (assuming hypoxia is often necessary) 

Once stabilised, the neurological examination includes evaluating the patient's consciousness, motor activity, and brainstem reflexes, all of which can help determine prognosis. Dr. Platt explained how rapid assessment provides crucial insights into survival outcomes within the first 48 hours. 

Diagnostic Imaging and Treatment 

When it comes to diagnostic tools, Dr. Platt recommended cerebral imaging. While standard radiographs can reveal skull fractures, they are less useful for treatment planning. CT scans are preferred for their ability to provide quick, detailed images of acute trauma, identifying issues such as hemorrhage, fractures, and vascular involvement. Meanwhile, MRI can detect more subtle injuries and provide predictive insights on survival outcomes. 

The treatment strategies were outlined in three levels: 

• Level 1: Patient resuscitation focusing on fluid management and oxygenation. 

• Level 2: Addressing patients showing signs of raised ICP, using diuretics, sedation, and pain management. 

• Level 3: Surgical intervention for patients unresponsive to previous treatments (refractory head trauma). 

Summary of Key Takeaways: 

• Hypoxia and hypotension must be addressed immediately to prevent further brain damage. 

• Fluid therapy and oxygenation are the most effective initial treatments for managing ICP. 

• There is currently a lack of evidence-based guidelines for some treatments, making secondary brain injury a critical focus for future therapy development. 

Common Questions and Expert Answers: 

1. What sedatives or pain management drugs are recommended? 
   Opioids like fentanyl are recommended due to their minimal cardiovascular effects and easy reversibility. Benzodiazepines are also favoured for their minimal impact on ICP. There is ongoing debate around dexmedetomidine due to its neuroprotective properties but also its potential to cause hypotension. 

1. Does Mannitol worsen intracranial bleeding? 
   According to research, this is not a concern. Mannitol is often used in managing ICP without exacerbating intracranial bleeding. 

1. Is there evidence supporting propylfentalline in head trauma? 
   Currently, there is no evidence suggesting that propylfentalline is effective in head trauma management, and there may be concerns about it increasing ICP. 

1. How soon after trauma could ICP changes become detectable? 
   Changes can occur immediately or up to 72 hours later. However, if the patient remains stable after 48 hours, further deterioration is less likely. 

1. How should neurogenic pulmonary oedema be managed? 
   Early intervention is critical. Oxygenation support, stress reduction, and the cautious use of furosemide (diuretic) can help manage the condition. 

Dr. Platt’s session provided a comprehensive and practical guide for veterinary professionals to improve outcomes for dogs and cats suffering from head trauma. His emphasis on timely intervention, imaging, and targeted treatment strategies serves as a valuable framework for veterinary emergency care. 

For more information and to watch this on-demand RACE-approved webinar, visit The Webinar Vet today!