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    Traumatic Brain Injury Management

    Critical Care / Resuscitation, Neurological, Trauma

    Last Updated Aug 02, 2018
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    By Mypinder Sekhon, Mypinder Sekhon

    Context

    Traumatic brain injury (TBI) is a major cause of long-term disability in young patients if crucial acute management steps are not taken to prevent additional brain hypoxia. Emerging evidence suggests that optimizing oxygen delivery to the brain in the early hours after the injury can improve long-term outcomes significantly.

    Traditionally, TBI has been associated with a fixed injury stemming from the initial insult; however, modification of the final neurological outcome is greatly impacted by resuscitation strategies aimed at preventing secondary ischemic brain injury.

    Recommended Treatment

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    TBI Protocol Appendix 

    Criteria For Hospital Admission

    History of acute traumatic brain injury with an un-confounded Glasgow Coma Score of < 15.

    Confounders include:

    1. Concomitant CNS depressant drug overdose (alcohol, psychotropics, benzodiazepines, opioids and barbiturates)
    2. Hypothermia (temperature < 34oC)
    3. Metabolic abnormalities (hypoglycemia, hypo or hypernatremia)

    Criteria For Transfer To Another Facility

    1. Traumatic Brain Injury fulfilling criteria of Canadian CT head rules (Moderate to severe traumatic brain injury (GCS 9-12 = Moderate; GCS < 9 = severe).
    2. Concomitant TBI with associated multisystem trauma.

     

    Transport considerations

    1. Consider intubation for all severe TBI patients (GCS < 9) for all ground and air transports.
    2. Use TBI checklist to optimize cerebral oxygen delivery and prevention of brain hypoxia.
    3. Transfers should be considered to be life-threatening.

    Criteria For Close Observation And/or Consult

    History of acute traumatic brain injury with an un-confounded Glasgow Coma Score of < 15.

    Criteria For Safe Discharge Home

    Not applicable for moderate to severe TBI patients.

    Quality Of Evidence?

    Justification

    Moderate

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