Head Trauma - Dr. Gibbs

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

---