Bart's Tips for successful TBI...part 2

Temperature mangement

Therapeutic hypothermia has shown great improvement in the cardiac arrest victims, however for the injured brain: “There is no evidence that hypothermia is beneficial in the treatment of head injury”.

Therapeutic hypothermia in the injured brain has resulted in more cases of coagulopathy, pneumonia and sepsis.

Bart’s recommend’s we should focus on “therapeutic normothermia” for these patient’s we know cooling is bad, but also fevers and hyperthermia is also detrimental as well.

We know fever increases cerebral metabolic rate and oxygen consumption with associated poor outcomes, however there is currently no good outcome studies to support this.

Take home point: fevers can develop quickly (yes even while the patient is still in ED), so monitor closely and treat aggressively.

Blood pressure

Patients with a severe brain injury often present with an abnormal blood pressure.

Hypotension is profoundly detrimental to these patient and needs to be treated aggressively to maintain cerebral perfusion pressure.

Hypertension can occur through the underlying physiological response to raised ICP, due to an underlying medical condition or may be related to pain and anxiety.

Treatment is generally not recommended in the hypertensive patient, remember these patients require sedatives and analgesia when intubated — providing this can relieve some of the hypertension.

On the rare occasion that you have to treat the high blood pressure, use short acting anti-hypertensive only and dose very gingerly