Severe traumatic brain injury

Question 1

treatment of severe TBI

Answer 1

Routinely administer oxygen.
* Ensure an open airway and adequate ventilation.
* Measure the blood glucose concentration and treat accordingly.
* Gain IV access.
* Administer 0.9% sodium chloride IV if there are signs of hypovolaemia or poor perfusion, or the systolic blood pressure is less than 120 mmHg in an adult, or less than the normal predicted systolic blood pressure in a child:
a) 1 litre for an adult.
b) 20 ml/kg for a child.
c) Administer one further bolus if required.
* Administer metaraminol IV in addition to 0.9% sodium chloride, if the systolic blood pressure is less than 120 mmHg in an adult, or less than the normal predicted systolic blood pressure in a child.

Question 2

The goal of treating a patient with severe TBI is to:

Answer 2

ū Recognise severe TBI, and
ū Minimise or prevent secondary brain injury, and
ū Treat other life-threatening injuries if present, and
ū Transport the patient to the most appropriate major trauma hospital
whenever this is feasible and safe.

Question 3

Secondary brain injury occurs when

Answer 3

a further physiological insult occurs to the brain after the primary (initial) injury.

Question 4

common causes of secondary brain injury

Answer 4

ū Hypoxia.
ū Hyperventilation. ū Hypoventilation. ū Hypotension.

Question 5

CPP is determined by

Answer 5

the mean arterial pressure (MAP) and the intracranial pressure (ICP) as per the formula: CPP = MAP – ICP.

Question 6

A reduction in CPP leads to

Answer 6

cerebral ischaemia which worsens outcome in patients with severe TBI.