Anesthesiology Oral Board Flash Cards > Disease States

Traumatic Brain Injury

"Hyperventilate or not? Hypercapnia increases cerebral blood volume (cerebral vasodilation). Hyperventilation previously used to manage TBI. However, studies show that cerebral blood flow is reduced by more than 50% (!) immediately after TBI and PaCO₂ <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?

Primary injury—initial physical injury (not modifiable); avoid secondary injury! Avoid hypotension, hypoxemia, fever, hyperglycemia, and hypercapnia

Risk factors—penetrating 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 ICP—4 components—reduce brain tissue—mannitol, hypertonic saline, surgery; reduce blood volume—hyperventilation, elevate head of bed 30 degrees, prevent seizures; reduce CSF—drain; remove pathologic lesions—hematoma, tumor