TBI

Question 1

What is the difference between mannitol and hypertonic saline action?

Answer 1

See meta-analysis

Question 2

When should you transfuse in TBI?

Answer 2

Restrictive - Transfuse if Hb<7
Liberal - Transfuse if Hb<10 if cardiac disease
**no benefit of liberal strategy if no cardiac history

Question 3

What is the PATCH trial?

Answer 3

Use of platelet transfusions in patients with spontaneous ICH taking anti-platelet agents.

Question 4

When should you do a CT scan for paediatric head injury?

Answer 4

See NICE guidelines (CHANCE, CHALICE and PECARN trials)

Question 5

What are Lunberg waves?

Answer 5

A - Plateau waves with rises in ICP over 5 mins
B - Oscillations in ICP rises up to 2 per minute likely representing vasogenic changes suggesting an unstable ICP
C - Rises in ICP of 4-8 per minute likely due to cardiogenic and vascular interaction

Question 6

What are the 3 peaks of an ICP waveform?

Answer 6

P1 - Percussion - arterial pulsation
P2 - Tidal - intracranial compliance
P3 - Dicrotic - closure of the aortic valve

**If P2 > P1 then loss of intracranial compliance suggesting intracranial hypertension

Question 7

What is a normal lactate:pyruvate ratio?

Answer 7

<20

Question 8

What are the causes of a raised Lactate:Pyruvate ratio in TBI?

Answer 8

Ischaemia (low oxygenation or low perfusion)
Mitochondrial damage
Hypoxia