Bart Besinger’s Tips for TBI

Bart Besinger’s Tips for TBI - Part 1

This week we will discuss Bart'sTips for TBI,it entails 5 topics:

Positioning,cervical collar,Blood Pressure,Blood sugar,and Temperature.

Today we discuss the first two items:

Patient Position

Elevating the head of the bed to 30° — will decrease ICP via displacing the CSF and increasing venous outflow.

By elevating the head of the bed to between 30°-45° also decrease the risk of developing ventilator associated pneumonia.

However elevating the head of the bed can be difficult in the patient with spinal precautions.

Bart also recommends avoiding the trendelenburg position (especially when inserting central lines) as this intervention offer’s little benefit but can greatly increase the ICP.

Cervical Collar

C-Spine collar aka “The Brain Tourniquet”.

Clearing the cervical spine of these patients can often be difficult in the comatosed intubated patient.

Removal of the C-spine collar has been showen to decrease ICP by around 2-5 mmHg.

If you are unable to remove the cervical collar check the position, size and tightness of the collar. Bart’s tip: loosen it up a bit so it aids venous return but still supports the head

Comments

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

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