Faculty

Muhammad Yusuf Bin Muharam

Dr Muhammad Yusuf bin Muharam is an Emergency Critical Care Physician & Head of Emergency & Trauma Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.

Graduated in 2003 from University of Malaya, Kuala Lumpur, and completed postgraduate Emergency Medicine training in 2013 from USM, Kelantan.

Completed Fellowship in Emergency Critical Care Ultrasound (WINFOCUS) in 2019, Fellowship (Subspecialty) Training in Emergency Critical Care, Ministry of Health, Malaysia in 2020.

Completed Clinical Attachment from Department of Anaesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Centre (BIDMC), Harvard Medical Faculty Practice in 2020.

Interest towards Emergency Critical Care & PoCUS in Emergency Department.

Explosion in My Brain: Please Help Me

Traumatic brain injury (TBI) is a leading cause of death and disability especially in trauma patients. Since primary brain injury is irreversible, management strategies must therefore focus on preventing secondary brain injury. This can be achieved by avoiding hypotension and hypoxia, at the same time maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow (CBF).

Emergency & Trauma Department (ETD) management started even from prehospital level via identification and initiation of management strategies even before arrival such as simple bedside maneuvers and pre-arrival notification to receiving team ideally trauma centre.

Maintenance of CPP either by increasing mean arterial pressure (MAP), decreasing intracranial pressure (ICP), or both. At times, pressors may be needed to prevent hypotension & maintain MAP in ideally euvolaemic condition.

In critically ill patient, often transfer is limited. Optic Nerve Sheath Diameter (ONSD) imaging as non-invasive screening tools can be used to identify increase ICP in ETD with high sensitivity & specificity. Transcranial Doppler (TCD) is another imaging that can also incorporated.

IV Tranexamic acid shows a significant reduction in risk of head injury-related mortality if administered within 3hrs of injury to patients with mild- to-moderate TBI (CRASH 3 Trial).

Other supportive consideration in the acute management of TBI patients includes stress ulcer & seizure prophylaxis as well as nutritional and metabolic optimization.

Definitive treatment may include multidisciplinary team approach especially in TBI associated with other injuries where surgical evacuation depending on size, clinical finding and ICP measurement.

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