Traumatic Brain Injury PART FIVE: Initial 48 Hours-Handout: TBI 5

Handout: TBI 5

Pdf Summary

The document is an educational statement on managing traumatic brain injuries (TBI) within the first 48 hours, authored by Dr. Lena O'Keefe from Yale University School of Medicine, and facilitated by the Trauma Center Association of America (TCAA). It is accredited for Continuing Medical Education (CME) credits and nursing contact hours. The summary provides detailed guidance based on case studies of traumatic brain injury management, using evidence from the Brain Trauma Foundation (BTF) and other professional societies.<br /><br />Key management points include:<br />- For epidural hematomas, surgery is indicated if the hematoma volume exceeds 30 cm³, thickness above 15 mm, midline shift over 5 mm, or if the patient is comatose. Initial management includes frequent neuro checks, anti-seizure prophylaxis, and reversed anticoagulation.<br />- Subdural hematomas require surgery if thickness is over 10 mm, midline shift exceeds 5 mm, or if Glasgow Coma Scale (GCS) drops by 2 points.<br />- Intracranial hypertension management involves hyperosmolar therapy and may include placing an intracranial monitor for patients at risk for high intracranial pressure (ICP).<br />- The discussion includes specific parameters for blood pressure management, the use of anticoagulation reversal, and strategies such as hyperventilation and administering tranexamic acid (TXA) for certain patients.<br />- For depressed skull fractures, surgical intervention is advised for open fractures depressed beyond skull thickness or with complications like sinus involvement.<br />- The guidelines suggest prophylactic antibiotics for penetrating brain injuries and specifics on antibiotic use in case of facial fractures or contamination.<br /> <br />The document emphasizes individualized clinical judgment guided by updated guidelines and the importance of continuous patient monitoring. Decisions should be based on specific symptoms and injury severity, with a focus on improving survival and neurological outcomes, especially within the critical initial period post-injury.

Keywords

Traumatic Brain Injury

TBI management

Dr. Lena O'Keefe

Yale University

Trauma Center Association of America

Continuing Medical Education

Brain Trauma Foundation

Intracranial hypertension

Epidural hematoma

Subdural hematoma