MANAGEMENT MODERATE TBI (GCS 9-12)

Question 1

Initial Management

Answer 1

Primary Survey & Resuscitation
Focused Neuro Exam: GCS, Pupils, Gross Motor Function
Secondary Survey & AMPLE
Consider reversal of Anticoagulation

Question 2

Diagnostics

Answer 2

CT Scan for ALL cases
Evaluation for other injuries
T&C, Coags

Question 3

Secondary Management

Answer 3

Serial Neurological Exams (q1-2 hrs)
repeat CT in 12-18 hrs

Question 4

Disposition

Answer 4

Trauma Center and Neurosurgical Consult

Repeat CT Scan in neurologcal deterioration (GCS 12->9) (10%) -> Escalate management to management of severe TBI

If improves -> D/C and follow up clinic

Question 5

Clinical Management Parameters

Answer 5

SBP > 100 mm Hg
Temp > 36-37.9 C
Sp02 >/ 95

Question 6

Laboratory Management Parameters

Answer 6

Glucose 4.4 - 10
Hgb > 70
INR < 1.4
Na 135-145
PaO2 > 100 mm Hg
PaCO2 35-45 mm Hg
pH 7.35 - 7.45
Plt >/ 75