Monitoring of TBI

Question 1

Monitoring patient with TBI

Answer 1

1. Modified GCS – looking for improvements over 24-48 hour period
2. Need to ensure not hypovolaemic or hypoxaemic
   Monitoring used in anaesthetised patients- But intermittently
   MBSA and mentation
   Blood pressure
   Blood gas
3. TLC – recumbent - turning, comfortable beds

Question 2

Advantages of urinary catheters in patient with TBI

Answer 2

Reduce urine scalding
Measure urine output and assess success of fluid therapy

Question 3

Disadvantages of urinary catheters in patients with TBI

Answer 3

> 50% dogs with indwelling catheters end up with UTI’s
Less likely with intermittent catheterisation than with permanent indwelling
Less likely in foals

Question 4

When to image a TBI patient

Answer 4

if barbiturate comas do not improve following unsuccessful stabilisation and management

Question 5

Usefulness of skull radiographs in TBI patients

Answer 5

Show calvaria fractures
don’t provide clinically useful information about brain injury

Question 6

usefulness of CT in TBI patients

Answer 6

Depending on availability
rapid scan times
better visualisation of fractures and peracute haemorrhage

Question 7

Common complications with TBI (5)

Answer 7

coagulopathies
pneumonia
sepsis
transient or permanent central diabetes insipidus
seizures

Question 8

How to ensure best prognosis for TBI

Answer 8

immediate and aggressive if the animal is to survive and recover to level functional and acceptable to the owner
Many patients can recover if systemic and neurologic abnormalities are identified and treated early