TBI
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any or all of the following: slowing pulse rate, increasing blood pressure, increasingly irregular respiratory patterns, altered level of consciousness, unequal pupils, repeating speech patterns, seizures, presence of CSF, with a history of head trauma.
EMPHASIS ON PATIENT CARE
Airway management, adequate oxygenation, spinal precautions
Be aware of the potential for spinal, abdominal or chest trauma not apparent due to altered mental status.
1. Primary Management - Assess ABC’s and manage as indicated. Avoid the three H-Bombs of TBI: Hypoxia, Hypotension, and Hyperventilation.
2. Secondary Management - History, physical exam, vital signs, and Glasgow Coma Scale.
AEMT
3. In route, initiate an IV/IO of an isotonic solution at a rate to maintain end organ perfusion. Consider second IV, if indicated.
4. Use a Buretrol IV set for PEDIATRICs. Consider intraosseous access, if peripheral venous access is not available and patient conditions warrants.
PARAMEDIC
a. PEARLS:
Prevention of hypoxia, hypotension, and hyperventilation (the three “H-bombs” of TBI) are imperative to prevent secondary brain injury.
Intubation should be approached with caution as it has been associated with worse outcomes when performed in the out-of-hospital environment for some patients with traumatic brain injury.
Both hypoxia and hyperoxia have been associated with increased mortality and worse discharge GCS scores in TBI (traumatic brain injury) patients.
Hyperventilation causes a decrease in the cerebral blood flow by vasoconstriction as a result of decreased levels of C02 (which is a vasodilator).
Hypoxia: maintain Pulse Ox of 100%. Hypotension: maintain BP systolic above 90. Optimal BP not known but higher is better in moderate to severe TBI. Do not hyperventilate: maintain End Tidal CO2 between 35 and 45.
TXA not routinely recommended for isolated TBI.
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any or all of the following: slowing pulse rate, increasing blood pressure, increasingly irregular respiratory patterns, altered level of consciousness, unequal pupils, repeating speech patterns, seizures, presence of CSF, with a history of head trauma.
EMPHASIS ON PATIENT CARE
Airway management, adequate oxygenation, spinal precautions
Be aware of the potential for spinal, abdominal or chest trauma not apparent due to altered mental status.
1. Primary Management - Assess ABC’s and manage as indicated. Avoid the three H-Bombs of TBI: Hypoxia, Hypotension, and Hyperventilation.
2. Secondary Management - History, physical exam, vital signs, and Glasgow Coma Scale.
AEMT
3. In route, initiate an IV/IO of an isotonic solution at a rate to maintain end organ perfusion. Consider second IV, if indicated.
4. Use a Buretrol IV set for PEDIATRICs. Consider intraosseous access, if peripheral venous access is not available and patient conditions warrants.
PARAMEDIC
a. PEARLS:
Prevention of hypoxia, hypotension, and hyperventilation (the three “H-bombs” of TBI) are imperative to prevent secondary brain injury.
Intubation should be approached with caution as it has been associated with worse outcomes when performed in the out-of-hospital environment for some patients with traumatic brain injury.
Both hypoxia and hyperoxia have been associated with increased mortality and worse discharge GCS scores in TBI (traumatic brain injury) patients.
Hyperventilation causes a decrease in the cerebral blood flow by vasoconstriction as a result of decreased levels of C02 (which is a vasodilator).
Hypoxia: maintain Pulse Ox of 100%. Hypotension: maintain BP systolic above 90. Optimal BP not known but higher is better in moderate to severe TBI. Do not hyperventilate: maintain End Tidal CO2 between 35 and 45.
TXA not routinely recommended for isolated TBI.