Neurocritical Care Review Course-Traumatic Brain Injury, Polytrauma, and Burns with TBI

Video Transcription

Video Summary

In this video, Dr. Dionne Spohr discusses the management of traumatic brain injury (TBI) in the neuroICU. She begins by defining and classifying TBI into closed brain injury and penetrating brain injury. She then reviews common findings on a head CT in patients with TBI, such as epidural and subdural hematomas, traumatic subarachnoid hemorrhage, diffuse axonal injury, and hemorrhagic contusion. Dr. Spohr emphasizes the importance of monitoring for and treating secondary brain injury, including hypoxia, hypotension, fever, hematoma expansion, intracranial hypertension, cerebral edema, herniation, and seizures. She explains the Glasgow Coma Scale (GCS) and its role in assessing TBI severity and emphasizes that it should not be used as a predictor of outcome. Dr. Spohr discusses the initial management of TBI, including airway management, treatment of hypoxia and hypotension, and the use of cervical collars. She highlights the importance of imaging, consultations with neurosurgery, and the appropriate ICU team. Dr. Spohr also discusses what to avoid in TBI, such as hyperventilation, steroids, and prophylactic hypothermia. She explains the assessment and management of cervical spine clearance in TBI patients. Dr. Spohr discusses the management of severe TBI in the setting of polytrauma and the challenges posed by concurrent TBI and burns. She then focuses on the treatment of TBI with a goal of reducing secondary brain injury. This includes hemodynamic monitoring targets, intracranial pressure (ICP) monitoring and management, brain tissue oxygen monitoring, and the use of osmotherapy to control ICP. Dr. Spohr also discusses the assessment and treatment of brain herniation, post-traumatic seizures, and post-traumatic vasospasm. She concludes with a summary slide highlighting the physiological targets and preventive measures for TBI management.

Asset Caption

Dionne Swor, MD

Keywords

traumatic brain injury

neuroICU

closed brain injury

penetrating brain injury

Glasgow Coma Scale

secondary brain injury

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