![]() Penetrating brain injury, especially with transverse object trajectories.CT angiography (CTA) may be needed to evaluate for blunt cerebrovascular injury (BCVI) involving the arteries (e.g., dissection or pseudoaneurysm).Repeat CT scanning should often be considered after 6-24 hours, based on initial CT scan, clinical evolution, and presence of anticoagulants.Even for isolated TBI, a C-spine CT scan is generally advisable.STAT head CT is indicated for any patient with significant TBI (e.g., GCS CT is the preferred modality due to its ability to detect bleeding or tissue shifts, its speed, and the ability to repeat the scan as needed.Coagulation studies (including INR, PTT, fibrinogen, +/- TEG if available). ![]() Basic labs (glucose, electrolytes, Mg/Phos, CBC).Chemical DVT prophylaxis is initially contraindicated use sequential compression devices upon admission.Maintain neck in a neutral position, D/C cervical collar ASAP.Target normocapnia (check ABG/VBG & trend etCO2).Aggressive fever management with scheduled acetaminophen and escalation to physical cooling if needed.Airway control as needed (with a Bp & ICP-stable intubation).Consider vEEG for comatose patients with possible seizures.Prophylactic levetiracetam (consider 2,000 mg load in high-risk patients).Empiric hypertonic tx is reasonable while awaiting STAT CT scan.Suggested by neuroworsening, anisocoria, or posturing.Recognizing & treating ICP crisis shortly after admission □ If hypotensive, start norepinephrine infusion immediately.Resuscitate as needed with blood products (in polytrauma with hemorrhagic shock) or crystalloid.Consider tranexamic acid if 70 YO: SBP >110 mm.Aggressive reversal of therapeutic anticoagulants.Consider vascular imaging of head and neck, at the same time. CT of head, cervical spine, and other relevant areas.Review of anticoagulant medications the patient is on. ![]() ABG or VBG if there is concern regarding hypoventilation. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |