Case #1 (minor TBI + discussion about clinical decision rules [CDR]) – SLIDE #30
· GCS 15 ≠ 14 ≠ 13
· Know what each CDR gets you
· Pick a rule and use it (ATLS prefers Canadian, ACEP prefers New Orleans, Gibbs prefers Canadian)
· Be cautious with the intoxicated patient (Canadian only 70% sensitive… must achieve clinical sobriety 1st)
Case #2 (TBI on warfarin) – SLIDE #49
· Very high risk… be liberal with imaging
· No CDR to identify the low-risk patient
· Order INR on arrival
· Reversal of anticoagulation = resuscitation!
Case #3 (severe TBI) – SLIDE #94
· RSI with neuroprotective drugs
· Hyperosmolar therapy with either hypertonic saline or mannitol
· Do not hyperventilate unless there is clear clinical evidence of herniation
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Charlotte, NC 28203