Traumatic Brain Injury Flashcards
What are signs of TBI?
Deteriorating mental status CSF otorrhea or rhinorrhea Seizures Abnormal breathing pattern Unstable VS
What are sx of TBI?
Loss of consciousness Amnesia Dizziness HA N/V Limb weakness
What are lab/diagnostics for TBI?
BMP ABG Urine drug screen Blood alcohol screen CT
What is a primary brain injury?
Occurs at the time of trauma
What is a secondary brain injury?
Occurs from time of event to ours and days after trauma
What are the scales for TBI classification?
15 = normal 13-15 = mild brain injury 9-12 = mod brain injury 3-8 = severe brain injury
What are TBI treatment goals?
CAB Minimize secondary neuronal injury Monitor and manage intracranial pressure Seizure prophylaxis/treatment Medical management
What is the primary goal of initial resuscitaiton?
Prevent hypotension and hypoxia
What is CAB?
Secure airway, ensure adequate oxygenation
How do we maintain blood flow to brain and other organs?
Crystalloids
Vasopressors PRN after restoration of intravascular volume
Blood products when available
How do we calculate CPP?
MAP - ICP
How do we calculate MAP?
(SBP + 2xDBP)/3
What is goal CPP?
50-70
What is goal ICP?
<20
What are methods to lower ICP?
Elevated head of bed 30+ degrees
Sedation, analgesics, anxiolytics
Avoid hyperventilation
Ventricular drainage of CSF
What is the DOC for lowering ICP d/t pain, agitation, resting mechanical ventilation?
Propofol
What drugs are used for sedation, analgesia, and anxiety?
Propofol
Opioids (fentanyl)
Benzos (midazolam)
What is used for osmotic therapy?
Mannitol
Why is mannitol used?
Diuretic to decrease ICP
Why is hypertonic saline used?
Decrease ICP
What is a last ditch effort and used in refractory ICP?
Barbiturates
What drugs are used for seizure prophylaxis?
VPA
Phenytoin
How long are AEDs used for?
7 day prophylaxis
What can accelerate functional recovery?
Amantadine
What is a neuroprotectant?
Allopregnanolone
