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Critical Care Mailbag – Head Trauma Etiquette

Rob Orman, MD and Scott Weingart, MD
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14:47
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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02:11

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EM:RAP 2017 January Written Summary 926 KB - PDF

Last month we talked about hypotension in head trauma. In this critical care mailbag, Scott lays out his optimal management of post intubation care of the head injured patients.

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Lily M. -

Are these goal SPO2 values based on sea level? Should it change for patients at 6,000 feet?

Kaitlin G. -

Thanks for having this topic! I was surprised to here that we should be targeting sBPs of 140-160 in traumatic head injuries. I am aware of the current guidelines regarding the management of hypertension in the setting of spontaneous ICH (although the evidence for these guidelines are lukewarm at best, especially in light of the ATTACH II trial ). However, with regards to traumatic ICH, the 2016 Brain Trauma Foundation do not mention anything about lowering BP, and it was my understanding that HTN in the setting of traumatic ICH is generally thought to reflect physiologic compensation in order to maintain CPP. Of course, if HTN is in the setting of cushing's or a blown pupil, then the patient should be treated with mannitol, hypertonic saline, or surgical decompression (but not antihypertensives). I would be really interested to read any studies that support lowering BP in the setting of traumatic ICH. Thank you!

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Broken Ankles, Ribs, and Pumps Full episode audio for MD edition 227:43 min - 318 MB - M4AEM:RAP 2017 January Canadian Edition Canadian 22:10 min - 31 MB - MP3EM:RAP 2017 January Australian Edition Australian 43:30 min - 60 MB - MP3EM:RAP 2017 January German Edition Deutsche 90:03 min - 124 MB - MP3EM:RAP 2017 January French Edition Français 32:33 min - 45 MB - MP3EM:RAP 2017 January Spanish Edition Español 65:46 min - 90 MB - MP3EM:RAP 2017 January Board Review Answers 220 KB - PDFEM:RAP 2017 January Board Review Questions 202 KB - PDFEM:RAP 2017 January Separate MP3 Files 265 MB - ZIPEM:RAP 2017 January Spanish Written Summary 1 MB - PDFEM:RAP 2017 January Written Summary 926 KB - PDF

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