Timely rescue of children with severe traumatic brain injury.

According to the report, patient D.D.P (18 months old, from Dien Chau district) fell down a staircase from a height of 2 meters, hitting his head on the hard floor. After the fall, the child was conscious and cried for a few minutes before gradually falling into a coma. The child was quickly taken by family members to a lower-level hospital for first aid before being transferred to a higher-level hospital.Nghe An Obstetrics and Pediatrics HospitalHere, the child was examined by doctors, underwent necessary diagnostic tests, and an emergency interdisciplinary consultation was urgently organized involving the Orthopedics - Burns, Surgical Intensive Care, and Anesthesia and Resuscitation departments.

The CT scan results showed that the child had multiple skull fractures (frontal, temporal, occipital, and parietal fractures), brain parenchyma contusion, subdural hematoma in the right cerebral hemisphere, and subarachnoid hemorrhage in the right frontal lobe causing falciform herniation.

The interdisciplinary consultation concluded with the following diagnosis: The child is in a coma with traumatic brain injury. There is a subdural hematoma in the right cerebral hemisphere, subarachnoid hemorrhage in the right frontal lobe, a fracture of the right frontotemporal bone, and suspected rupture of the superior sagittal sinus.

The child was indicated for emergency craniotomy to decompress the hematoma and control bleeding. During the surgery, the child was intubated under general anesthesia, and the surgical team made a question mark-shaped incision in the right temporofrontal-parietal region. The surgical team then quickly dissected the tissue to expose the skull bone. A fracture of the right temporofrontal skull through the midline was observed, causing a tear in the dura mater and a rupture of the superior sagittal sinus, resulting in profuse bleeding. This was accompanied by significant extracorporeal brain tissue, causing hypotension.

The surgeons promptly performed temporary hemostasis, widened the skull to remove approximately 50ml of subdural hematoma, sutured the venous sinus to control bleeding, placed a drain, and reconstructed the dura mater. During the surgery, the patient received 2 units of packed red blood cells and 2 units of fresh frozen plasma... After more than 2 hours of tense surgery, the operation was successfully completed; the child continued to receive intensive post-operative care and resuscitation in the Surgical Intensive Care Unit.

Dr. Phan Van Huy, Deputy Head of the Orthopedics and Burns Department, said: Traumatic brain injury is the leading cause of death and disability in children. The venous sinus injury of patient D.D.P. caused acute blood loss; without timely treatment, the patient could have died on the operating table. In P.'s case, the surgical team performed the surgery as quickly as possible, immediately after the intervention was indicated to remove the subdural hematoma, control bleeding from the torn venous sinus, and limit secondary nerve damage. The success of the surgery came from the close, coordinated, and precise cooperation between the Orthopedics, Anesthesia and Resuscitation, and Surgical Intensive Care departments to save the child from further complications.criticalon the operating table.

Seven days after surgery, the child is out of critical condition, alert, and has had the endotracheal tube removed. The child is receiving supportive medical treatment, wound care, and monitoring for other potential post-operative complications.

Through this, doctors advise: Common causes of traumatic brain injury in young children are traffic accidents and household accidents (falls while climbing, heavy objects hitting the head, etc.). Therefore, families and schools need to pay attention to children to ensure their safety. In the unfortunate event of an accident, families need to closely monitor the child's condition, consciousness, and any unusual symptoms (headache, vomiting, paralysis, etc.). If a traumatic brain injury is suspected, the child should be taken immediately to a medical facility for examination and timely treatment.