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Originally Posted by AF IDMT
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!  |
Hyperventilation is used to treat patients with increased intracranial pressure. It causes vasoconstriction, which prevents blood flow to the brain. In patients with bad head injuries they have an increase in their intracranial pressure and by decreasing the amount of the blood flow to the brain you decrease the pressure in the brain. Decreasing the blood flow to your brain is not always the best thing to do. In the past people were pretty aggressive about hyperventilating patients with significant head injuries, but as you mentioned there have been some new studies that showed that prolonged hyperventilation can be harmful. The practice pattern by the neurocritical care people at my institution is to withhold significant hyperventilation until a patient appears to be herniating. In this particular setting the patient appears to be herniating and it would be indicated to proceed with hyperventilation. If I was taking care of this patient and I was in the field I would hyperventilate him as long as it takes regardless of transport time given his significant head injury with likely herniation.
Here are some good articles about fluid resuscitation.
1. Butler, F K Jr; Hagmann, J; Butler, E G. Tactical combat casualty care in special operations. Military medicine. 1996; 161 Supplement: 3-16.
2. Bickell WH, Wall MJ, Pepe PE, Martin RR, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. The New England journal of medicine. 1994; 331: 1105-1109.
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