Traumatic Brain Injury SOP Flashcards
Outline the contents of the traumatic brain injury SOP
Applies to all clinical staff
Covers:
Patient assessment
Targeted treatment
PHEA
Ventilation strategies
Hypotension management
Use of TXA
Packaging
ICP Control
Triage
Outline the particulars of patient assessment in the context of TBI
Accurate GCS
Document limb movement
Assess pupils
Check BM
How would you treat hypoglycaemia (CBG <4) as per the TBI SOP?
2ml/kg of 10% Glucose
What are the treatment targets in TBI?
Minimise secondary brain injury
Avoidance of:
- hypoxia
- hypotension
- hypoglycaemia
- seizures
- cerebral oedema
- raised ICP
Outline the particulars of PHEA in relation to TBI
Meticulous pre-O2
Consider A. line
Gentle laryngoscopy
Adequate sedation and paralysis
Ventilate ASAP
What are the ventilation targets in TBI?
Sats >94%
Minimise PEEP to 5
ETCO2 4
What are the BP targets in TBI?
CPP = MAP - ICP
Isolated head - 120
Multi-system - 90-100
Under what circumstances should TXA be given to a patient with TBI?
GCS<13
What dose of TXA should be given to a patient with TBI?
2g
15-30 mg/kg for paeds
Blue bag medicines pouch
What are the practicalities of patient packaging in relation to TBI?
Collar off
20-30 degrees head up
Allow passive cooling, avoid hyperthermia
What is the indication for hypertonic saline in the context of TBI?
Persistent signs of critically raised ICP (pupils or CVS response) despite:
- oxygenation
- sedation
- positioning
- optimised ventilation
What is the dose of hypertonic saline for raised ICP?
3ml/kg 2.7% NaCl via large bore cannula
Fluids pouch blue bag
Outline the elements of triage in relation to TBI
MTC - GCS <13 or skull fracture
Local - anyone else
Discharge - rule out spinal injury, discharge advice and responsible adult
