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Originally Posted by bdonham
Shadowflyer- great thread. Thanks for posting.
A few points about the case-
1. TBI: With traumatic brain injury the most important things you can do in the pre-hospital environment is to insure good cerebral perfusion pressure (the pressure driving blood to the brain), and good oxygenation. With TBI there are areas of brain that are injured, but have the potential to recover. With hypotension or hypoxia you end up not getting enough oxygen and nutrients to the area of potential salvageable brain, thus causing irreversibly injury. Although current teaching is to use hypotensive resuscitation, this patient does have a TBI and he should receive aggressive fluid resuscitation. Because of the need for optimal oxygenation, and given that this guy is not protecting his airway he probably needs be intubated. A nasotracheal intubation should not be attempted because of his likely facial fractures.
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Since reading this post I am wading through my fourth TBI article with many more to go. One item I did run across was the statement that hyperventilation while useful in controlling intercranial pressure due to vasoconstriction if continued long term (relative?) could prove harmful due to lack of blood flow to the injured area. My question is in a field setting at what point do you stop hyperventilating the patient if you have a long transport time to the trauma center? I am still trying to find some more info on fluid resuscitation but I haven't , , , yet!
