Case No.: Date:

SUBJECTIVEOBJECTIVEASSESSMENTPLANPATIENT EDUCATION

PROBLEM

1.VITAL SIGNS2.LAB TESTS3.MED.LIST

ETIOLOGY OF PROBLEM

1.EVALUATE CURRENT THERAPY FOR PROBLEM2.EVALUATE NEED FOR THERAPY

GOALS FOR TREATMENT OF PROBLEM

RECOMMEND1. DRUG TREATMENT FOR PROBLEM2. MONITORING PARAMETERS FOR EACH DRUG LISTED3. FURTHER TESTS FOR PROBLEM IF NEEDED4. DRUGS TO BE AVOIDED AND WHY

SUB-DURAL HEMATOMA

18 y/o male patient was admitted in a MICU ward.C/O: Alleged H/O RTA, head injury. Lacerated injury on left side of forehead around 5 x 1.5 cm. PMH: Non- remarkable prior to admission.

Vitals:PR - 82/minBP - 110/80 mmHgSPO2 - 98 %Temp- 98.4 F

RadiologyCT Scan: Small Subdural Hematoma

Current medication:Inj . Piracetam 12g BD with 500 ml NSInj. Citicoline 500mg BDInj . Mannitol 20% BDInj. Phenytoin 100mg TDSInj. Pantaprazole 40mg ODInj. Ondansetron 4mg ODInj. Meropenam 1g BDInj. Imipenem and Cilastatin 1g BDA subdural hematoma is a collection of blood outside the brain. Subdural hematomas are usually caused by severe head injuries. The bleeding and increased pressure on the brain from a subdural hematoma can be life-threatening. Some subdural hematomas stop and resolve spontaneously; others require surgical drainage.1. In small subdural hematomas with mild symptoms, doctors may recommend no specific treatment other than observation. Repeated head imaging tests are often performed to demonstrate the subdural hematoma is improving.

2. The required therapy for sub dural hemorrhage is to prevent the bleeding in the sub dural space of brain.The goal of treatment is to control symptoms and reduce or prevent permanent damage to the brain.

1. 1. The medication Mannitol to help reduce swelling or pressure in the brain. Phenytoin to control seizures

2. Parameters to be monitored in case of mannitol include intracranial pressure and cerebral blood flow using laser Doppler flowmetry.*Phenytoin admimistration should need to monitor the parameters of cardiovascular system because of the risk of severe hypertension and cardiac arrhythmias.*cardiac monitoring and blood pressure monitoring should be done while using pantoprazole.

3. .MRI should done if needed. Repeated head imaging tests are often performed to demonstrate the subdural hematoma is improving.4. anti coagulants should be avoided because it worsen the hemorrhage.1.Always use safety equipment at work and play to reduce your risk of a head injury .2.Advice the patient on taking medication.3.Phenytoin levels may decrease when the suspension is given with enteral feedings. This could lead to a loss of seizure control hence interrupt the feeding for 2 hours before and after the phenytoin dose.

Department of Pharmacy Practice, Sri Venkateswara College of Pharmacy, RVS Nagar, Chittoor-517127 (AP), INDIA