Question

Joe suffered severe head trauma. His initial lab tests (blood and urine) were within normal limits. On the second day of hospitalization, he is breathing irregularly, his skin is dry and flaccid, and his urine reservoir has been emptied several times that day. The physician orders urine tests for the presence of glucose and ketones. These tests are negative. What other tests would you do? What is the most likely cause of his difficulties?

Answer 1

The other tests that we would do are;

1) ABG analysis.

2) CT Scan

3) MRI

4) monitoring intra-cranial pressure

5) pulmonary function test

Traumatic Brain Injury is a non degenerative, non congenital lesion caused by trauma or triggered by high energy acceleration of decelaration of the brain inside the skull that cause anatomical damage to or has functional effect on the scalp, skull, meninges or encephalon. Breathing is controlled centrally by the brain stem. It receives input from central and peripheral chemoreceptors as well as voluntary control from the cerebrum. Brainstem also receives input from chemoreceptors and adjusts the rate of tidal volumes based on pH and partial pressure of CO2.

Agonal breathing is characterized by slow very shallow irregular respirations that result from anoxic brain injury. This usually leads to apnea. This may be caused due to brain hypoxia or lack of cerebral perfusion.

Usually these patients should be incubated and put on mechanical ventilator.