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Anesthesiology Oral Board Flash Cards
Traumatic Brain Injury
Considerations, History, Physical Exam, Lab Tests/Imaging, Consults, Conflict(s), Optimize/Goals, Options, Preop:, Room Setup (Special Drugs/Monitors), Induction, Maintenance, Emergence, Disposition/Pain, Clinical Pearl, Reference
Hyperventilate or not? Hypercapnia increases cerebral blood volume (cerebral vasodilation). Hyperventilation previously used to manage TBI. However, studies show that cerebral blood flow is
by more than 50% (!) immediately after TBI and PaCO
<30 mm Hg correlates with poorer outcome. Therefore, avoid in the first 24 hours after injury and only consider hyperventilation as a temporizing measure for signs of brain herniation (abnormal posturing, altered LOC, dilated pupils, and vomiting)
Emergency? Follow ACLS/ATLS guidelines
C-spine injury? Other injury? Full stomach?
initial physical injury (not modifiable); avoid
! Avoid hypotension, hypoxemia, fever, hyperglycemia, and hypercapnia
Risk factorspenetrating injury (worse than blunt), pedestrian or cyclist (worse than vehicle occupants), ejection from vehicle, increased age
Ensure cerebral perfusion pressure (CPP) >60 mm Hg. (CPP = MAP ICP)
Reduce elevations in ICP4 components
reduce brain tissue
mannitol, hypertonic saline, surgery;
reduce blood volume
hyperventilation, elevate head of bed 30 degrees, prevent seizures;
remove pathologic lesions
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