Traumatic Brain Injury

Question 1

What are the clinical features of a TBI?

Answer 1

1. External evidence of head injury:
   - scalp abrasion, laceration, haematoma, complaining of headache
   - obvious depressed skull fracture / open head injury
   - blood from ears or nose (suggestive of base of skull injury)
   - brain matter on view is an extremely poor prognostic sign
2. ALOC / focal neurology:
   - reduced GCS (patients may be agitated and appear intoxicated)
   - unilateral weakness, seizure, unequal / unreactive / dilated pupils
3. Abnormal vital signs:
   - bradycardia & hypertension (cushing’s reflex) is a sign of raised ICP
   - hypoxia or hypotension have important prognostic implications
   - exclusion of hypoglycaemia is essential

Question 2

Outline the management of a patient with a TBI.

Answer 2

GCS 15?

If no:
1. O2
2. IV access
3. IV fluid (SBP 100-120 mmHg)

Consider:
- basic airway adjuncts
- c-spine support
- analgesia
- midazolam
- hypertonic saline 7.5%
- antiemetic (ondansetron)
TRANSPORT

If yes:
Consider:
- c-spine support
- O2
- IV access
- analgesia
- IV fluid
TRANSPORT

Question 3

How do we avoid raise ICP from impaired venous return?

Answer 3

1. Ensuring constricting tapes, ties and collars are loosened from around the neck
2. Position the patient head up to 30 degrees if possible