Traumatic Brain Injury
Tier Zero - All TBI patients
- Is MAP > 80 mmHg if GCS < 8 or >70 mmHg if GCS >8?
- Are O2 sats > 92%
- Is HOB at 30 degrees and midline?
- Is serum sodium > 140 mEq/L?
- Is temperature no higher than 37 C?
- Is coagulopathy corrected with PCC?
Tier One - All TBI patients with GCS < 8
- Is the patient intubated?
- Is PaCO2 35-40 mmHg?
- Is PaO2 80-120 mmHg?
- Is fluid balance positive by 500 - 1000ml in first 24 hrs?
- Is MAP > 80 mmHg if no ICP monitor?
- Is CPP > 60 mmHg?
- Is ICP < 20 mmHg?
- Are serum electrolytes and osmo ordered q 6 hrs?
- Has osmolar therapy been started with hypteronic saline or mannitol?
- Is serum sodium < 160 mEq?
- Has continuous EEG been done to R/O non-convulsive seizures?
- Has anti-seizure prophylaxis been started?
Tier Two - If ICP > 20 mHg for 60 mins
- Are goals of Tier One met?
- Is CT scan needed?
- Has a paralytic agent been initiated?
- Is hypothermia indicated (35 C)
- Can PaCO2 be decreased to 30-34 mmHg?
Tier Three - ICP remains > 20 mHg
- Are all goals of other tiers maximized?
- Can 23.4% hypertonic saline be given?
- Is EEG continuous?
- Has surgical decompression been discussed?
- Can temperature be decreased to 34 C?
- Is patient a candidate for barbituate coma?
Traumatic Brain Injury guideline
Powered by SurgicalCriticalCare.net