Management Considerations with TBI

VBMC TRAUMA CARE SERVICES GUIDELINE

Management considerations with TBI

Operating Room:

In OR from ER: consider ICP monitor if unstable. CT head prior to OR if stable.

Correct coagulopathy intra-op if necessary.

Will usually have HOB flat which may exacerbate ICH.

Simultaneous craniotomy and ex-lap may (rarely) be necessary.

Interventional Radiology

Limitations for ICP monitoring during procedure.

Will have HOB flat which may exacerbate ICH.

High risk for TBI progression.

Chest Trauma

Analgesia clouds neuro exam.

Cardiac contusion

May need echo or PAC to ensure CO/CPP.

MI/PE

May need anticoagulation if life-threatening MI or PE.

Need ICP monitor.

Aortic dissection

Beta blockers decrease CPP and may exacerbate TBI.

Though IR suites have limited monitoring, endografts may require less long-term antiplatelet/anticoag meds.

Abdominal Compartment Syndrome

Opening abdomen decreases ICP but multiple OR trips with fluids/pressors/Lasix can exacerbate TBI.

Use paralytics early in these patients to reduce intrathoracic pressure.

Long-bone fractures

Operate as soon as the risk of exacerbating TBI is minimized.

Replace EBL and avoid shock.

Fat Emboli in up to 15% of TBI/Femur combos

Spinal cord Injury

Early fixation/fusion, but prone position can exacerbate ICP so may need ICP monitor.

Frontal Sinus

Fix early if high CSF leak, pneumocephalus, duct involvement, or significant TBI.

CSF Leaks

If from basilar skull fx (1/3) then they usually close spontaneously.

Operate and/or Drainage if no decrease in volume, leak is persistent, or meningitis.

Nonop tx:

· Bedrest with HOB 15-20

· No caffeine.

· No LP.