Traumatic Brain Injury - Trauma

Question 1

If a patient with a traumatic brain injury is hypotensive what boluses should be considered?

Answer 1

NS/Ringers 10mL/kg PRN

PRBCs when indicated

Question 2

If a patient with a traumatic head injury is hypotensive refractory to a fluid bolus, what medication should you consider and at what starting dose? What MAP are you targeting?

Answer 2

Norepinephrine starting at 0.05 mcg/kg/min titrating up to 0.5 mcg/kg/min to achieve a MAP of >80 mmHg

Question 3

If a patient has a traumatic brain injury what is your target ETCO2? What if they show signs of herniation?

Answer 3

33-38 mmHg, if pt herniating target ETCO2 of 30-35 mmHg

Question 4

In patching with a patient with a traumatic brain injury when should you use hypertonic saline (3%) vs Mannitol?

Answer 4

Hypertonic saline (3 ml/kg) should be considered if the MAP <80 mmHg
Mannitol (1g/kg) should be considered if MAP >80

Note: Mannitol onset is 15-30 min whereas hypertonic saline is immediate

Question 5

In a patient with a traumatic brain injury hyperoxemia should be avoided due to increased mortality, what’s the target SPO2?

Answer 5

Maintain an SPO2 of 94-98% with traumatic brain injury

Question 5

In a patient with a traumatic brain injury hyperoxemia should be avoided due to increased mortality, what’s the target SPO2?

Answer 5

Maintain an SPO2 of 94-98% with traumatic brain injury