Thoracoabdominal Crush Causes Increased Intracranial Pressure Resulting in Detectable with Eye Tracking Technology and Blood Based Biomarkers Daniel James Rafter MD; Uzma Samadani MD

Introduction Learning Objectives References , R. et al. Elevated intracranial Conventionally traumatic brain - Isolated thoracoabdominal crush Lees DH. Severe Abdominal Crush pressure and reversible eye-tracking (TBIs) have been associated injury increases intrathoracic and Injury. British Medical Journal. changes detected while viewing a film with a clear trauma to the head. intraabdominal pressures which may 1944;2(4382):853-854. clip. Journal of Neurosurgery 128, Results However, patients with elevated lead to decreased cerebral venous Samadani, U. et al. Detection of third 811–818 (2018). Serum biomarkers and eye tracking intrathoracic (ITP) and intraabdominal return and in turn increase and sixth cranial nerve palsies with a .Lees, D. H. Severe Abdominal Crush metrics in patients with significant pressures (IAP) as a result of crush intracranial pressure (ICP). novel method for eye tracking while Injury. Bmj 2, 853–854 (1944). isolated throacoabdominal crush injuries may potentially also have watching a short film clip. Research 2, Sertaridou, E., Papaioannou, V., injury more closely resembled those potentially undiagnosed TBI due to 707–720 (2014). Kouliatsis, G., Theodorou, V. & found in the CT-scan positive TBI - This elevated ICP results in elevated intracranial pressure (ICP). Papavramidis TS, Marinis AD, Pliakos Pneumatikos, I. Traumatic population versus healthy controls. intracranial trauma producing I, Kesisoglou I, Papavramidou N. due to blunt chest trauma: a case GFAP levels at the time of admission elevated biomarker concentrations as Abdominal – report and literature review. Journal of Methods for an isolated thoracoabdominal well as ocular dysmolities which have Intra-abdominal hypertension: Medical Case Reports 6, (2012). We prospectively recruited 625 crush subject as well as those with been shown to indicate a traumatic Defining, diagnosing, and managing. Peponis, T. & King, D. R. Intracranial trauma subjects and healthy non- and blunt head trauma brain injury (TBI). Journal of Emergencies, Trauma and Pressure Monitoring in Severe trauma controls in whom we analyzed were elevated when compared to the . 2011;4(2):279-291. Traumatic Brain Injury. Oxford serum samples and performed control population [4549.6 ± 9951.0] - Isolated extremity crush injuries do doi:10.4103/0974-2700.82224. Medicine Online (2018). eyetracking to characterize and vs [11.5 ± 8.9]. Eye tracking not produce findings similar to those Sertaridou E, Papaioannou V, doi:10.1093/med/9780190467654.003 classify the nature of their brain metrics, indicative of elevated ICP, found in TBI which suggests that Kouliatsis G, Theodorou V, .0007 injury, if any. Eight subjects were were also found to be altered in both redistribution of blood volume is not Pneumatikos I. Google Search Available at: noted to have sustained crush injuries isolated thoracoabdominal crush significant enough to cause a due to blunt chest trauma: a case https://www.google.com/search?q=oc and were subcategorized as isolated subjects. Patients with isolated significant elevation in ICP. report and literature review. Journal ulomotor%2Bnerve%2Bpalsy&tbm=vid thoracoabdominal, thoracoabdominal extremity crush had levels of GFAP of Medical Case Reports. 2012;6:257. &source=lnms&sa=X&ved=0ahUKEwio with blunt head trauma, isolated and eye tracking similar to healthy doi:10.1186/1752-1947-6-257. lJP71p7ZAhVp5oMKHZwyD20Q_AUICy extremity, and extremity with blunt non-trauma controls. Hawthorne, C. & Piper, I. Monitoring gC&biw=1920&bih=949&dpr=1. head trauma. The eye tracking of Intracranial Pressure in Patients (Accessed: 2nd March 2018) metrics and biomarker concentrations Conclusions with Traumatic Brain Injury. Frontiers Abdominal Compartment Syndrome. were then compared to non-trauma Thoracoabdominal but not extremity in Neurology 5, (2014). Practice Essentials, Pathophysiology, control and known TBI subjects. crush can lead to elevated ICP Kirkman, M. & Smith, M. Intracranial Etiology (2017). Available at: resulting in eye tracking and serum pressure monitoring, cerebral https://emedicine.medscape.com/artic biomarker findings consistent with perfusion pressure estimation, and le/829008-overview. (Accessed: 2nd brain injury. Future work may elicit ICP/CPP-guided therapy: a standard March 2018) the intraabdominal pressure and of care or optional extra after brain Crush injury. MedlinePlus Medical intrathoracic pressure elevation injury? British Journal of Anaesthesia Encyclopedia Available at: necessary to increase the ICP and 112, 35–46 (2014). https://medlineplus.gov/ency/article/0 produce these demonstrated ocular Peponis, T. & King, D. R. Intracranial 00024.htm. (Accessed: 2nd March motility dysfunctions as well as Pressure Monitoring in Severe 2018) explore the impact of other crush Traumatic Brain Injury. Oxford Crush Injury and Crush Syndrome. injuries on ICP. Medicine Online (2018). American College of Emergency doi:10.1093/med/9780190467654.00 Physicians - Crush Injury and Crush 3.0007 Syndrome(2009). Available at:

https://www.acep.org/MobileArticle.as px?id=46079&parentid=740. (Accessed: 5th March 2018)