5- Treatment principles with traumatic brain injury

Question 1

What is the first goal of treating a traumatic brain injury

Answer 1

Extracranial stabilisation
- correction of tissue perfusion deficits (hypovolaemia)
- optimising systemic oxygenation and ventilation

Question 2

List 3 goals for intracranial stabilisation

Answer 2

Optimising cerebral perfusion
Decreasing ICP (intracranial pressure)
Minimising increases in cerebral metabolic rate

Question 3

T/F fluid therapy in traumatic brain injury is contraindication

Answer 3

False
fluid restriction does not reduce or prevent cerebral oedema

Question 4

T/F 7.2% hypertonic saline is a good option to give

Answer 4

True
will rapidly restore circulating volume
increased osmolarity draws fluid from interstitium thus decreasing oedema
MUST follow with Hartmanns

Question 5

How can we minimise increases in ICP

Answer 5

Raise head and neck by 15-30o from horizontal

Question 6

What is mannitol?

Answer 6

osmotic diuretic - used for severe TBI & neurologic deterioration

Question 7

What type of fluid should be used in a tbi?

Answer 7

Either 1/4 of the ‘shock rates’
- 15-20ml/kg bolus of Hartmanns or 2.5-5ml/kg colloids
OR
Hypertonic saline (4ml/kg) over 3-5 mins following with a crystalloid (Hartmanns)

Question 8

T/F hyperglycaemia is associated with severity of TBI

Answer 8

True
Associated with increased mortality rates or worsened neurologic outcomes in human patients with head trauma

Question 9

How is hypothermia beneficial in TBI’s?

Answer 9

Decreases brains metabolic demands > decreasing cerebral oedema & ICP

(Reduction in glutamate (excitatory neurotransmitter)

May also reduce secondary brain injury by inhibition of post-traumatic inflammatory response including reduction in release of inflammatory ytokines and preservation of the BBB

Question 10

What body state is important to avoid when we have TBI

Answer 10

hyperthermia- increase ICP

Question 11

T/F anti-convulsant therapy can be used in TBI’s

Answer 11

True - between 4-42% show seizures

Question 12

T/F Low PaCO2 leads to vasodilation and worsening of ICP in TBI patients

Answer 12

False- high PaCO2 does this

Question 13

List some disadvantages of induced hypothermia

Answer 13

coagulation disorders
increased susceptibility to infections
hypotension
bradycardia
dysrhythmias

Question 14

List some risk factors of seizure in TBI patients

Answer 14

severity of injury
depressed skull fractures
epidural, subdural and intra-cerebral haematomas
penetrating head wounds
seizure within the first 24 hours following injury

Question 15

What drug can be used to prevent seizures

Answer 15

Phenobarbitone

Question 16

What drug can be used to stop seizures

Answer 16

Diazepam (is a benzodiazepine)