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48 - Severe Traumatic Brain Injury

from Section 11 - Trauma

Published online by Cambridge University Press:  02 November 2023

Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Severe traumatic brain injury (TBI) is usually defined as a Glasgow Coma Scale (GCS) score < 9. The goals of early resuscitation should focus on identifying and treating the primary injuries and limiting the negative cascade of secondary injuries such as hypotension and hypoxia. All patients with suspected severe TBI need an emergent computed tomography (CT) scan of the brain to identify hemorrhage immediately following initial stabilization. Ten percent of severe TBI patients have concomitant c-spine injury.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Al-Rawi, PG, Tseng, MY, Richards, HK, et al. Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH. Stroke. 2010;41:122128.CrossRefGoogle ScholarPubMed
Blaivas, M, Theodoro, D, Sierzenski, PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 2003;10:376381.CrossRefGoogle ScholarPubMed
Bourgoin, A, Albanèse, J, Léone, M, et al. Effects of sufentanil or ketamine administered in target-controlled infusion on the cerebral hemodynamics of severely brain-injured patients. Crit Care Med 2005;33:11091113.CrossRefGoogle ScholarPubMed
Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton, SL, Chestnut, RM, Ghajar, J, et al. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007;24 Suppl 1:S1106.Google ScholarPubMed
Bullock, M, Chesnut, R, Ghajar, J, et al. Guidelines for the surgical management of traumatic brain injury. Neurosurgery 2006;58(3) Supplement:S2–47–S2–55.Google Scholar
Crashingpatient.com [homepage on the Internet]. New York, NY: Scott Weingart; ©2006–2012 [updated 2012; cited August 1, 2012]. Available from: www.crashingpatient.com/ [last accessed February 17, 2023].Google Scholar
Eisenberg, HM, Frankowski, RF, Contant, CF, et al. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988;69:1523.CrossRefGoogle ScholarPubMed
Emcrit.org [home page on the Internet]. New York, NY: Scott Weingart; c2008–2012 [updated 2012; cited 2012 Aug 1]. Available from: www.emcrit.org/ [last accessed February 17, 2023].Google Scholar
Fredriksson, K, Norrving, B, Strömblad, LG. Emergency reversal of anticoagulation after intracerebral hemorrhage. Stroke 1992;23:972977.CrossRefGoogle ScholarPubMed
Kelly, DF, Goodale, DB, Williams, J, et al. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg 1999;90:10421052.CrossRefGoogle ScholarPubMed
Kerr, ME, Sereika, SM, Orndoff, P, et al. Effect of neuromuscular blockers and opiates on the cerebrovascular response to endotracheal suctioning in adults with severe head injuries. Am J Crit Care 1998;7:205217.CrossRefGoogle ScholarPubMed
Samama, CM. Prothrombin complex concentrates: a brief review. Eur J Anaesthesiol 2008;25:784789.CrossRefGoogle ScholarPubMed
Swadron, SP, Leroux, P, Smith, WS, et al.. Emergency neurological life support: traumatic brain injury. Neurocrit Care 2012;17 Suppl 1: 112121.CrossRefGoogle ScholarPubMed
Vigué, B. Bench-to-bedside review: optimising emergency reversal of vitamin K antagonists in severe haemorrhage – from theory to practice. Crit Care 2009;13:209.CrossRefGoogle ScholarPubMed

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