Listen Now:
http://traffic.libsyn.com/specialoperationsmedicine/PFC_TBI_update_Final.mp3
Show Notes:
Positioning
- Keep head at 30° or higher
Seizure Prophylaxis
- Keppra 1.5g initial dose 500mg every 12 hours
- Barbituates by telemedical consult
Seizure treatment
- Midazolam
Monitoring
- Compare serial measurements of Optic Nerve Disc Sheath Diameter
Impending Herniation Treatment
- Hypertonic Saline 23.4% vial or 3% 250mL
- Sodium Bicarbonate also acceptable
Palliative Care for Expectant Patients
- Have a plan or Call Telemedicine
Check out our previous TBI content:
Traumatic Brain Injuries coupled with other injuries can be one of the most difficult wound patterns to manage in the field. Learn to manage TBI on its own and when other complications arrive you will be in better condition to handle an even more difficult situation.
This Clinical Practice Guideline was initially drafted after our meeting in December of 2015. We wanted to make sure that we had a majority consensus from operational Medics and Docs along with the Researchers and clinicians in each recommendation we made, making this a 2-year endeavor. It was a long hard road to reconcile all the “Best” recommendations possible in a “House” phase with what a Medic should be expected to handle out of his ruck near the point of injury. There are a few interventions that some medics may not be famiar with, or drugs that are not commonly carried out side of a larger treatment facility. In these instances we realize that situations and even budgets may dictate what you have available. This still doesn’t change what is best for the patient. If it is physically possible and backed by evidence we included it as a “Best” recommendation with options for alternate therapies below them. This could also be a catalyst for change and improvement by giving the medical planner (usually the Medic) justification to make a request out of the ordinary.
This was the case 4 years ago with some of our MEDLOGs when we would request 10 vials of Ketamine for a 4 month Africa Deployment and they would respond by issuing 3 vials, saying that we don’t really need that much. In fact when we layed out the math it was evident that three was woefully inadequate.
Sometimes it is not so straightforward with hard math to back you. Sometimes you need a consensus guideline to help push naysayers in the right direction. We hope these recommendations by our Working Group and the Joint Trauma System have the clout you need to increase your medical capabilities and ultimately the care you provide.
If you are not a SOMA Member and missed the article in the Journal of Special Operations Medicine you can download the guidelines from the JTS CPG webpage or via the link below. Since it is now considered a scholarly article this is also archived in the NIH PubMed Database for future reference.
Check out our previous posts and podcasts on TBI management:
Podcast Episode 20: TBI Round Table and Case Discussion
Podcast Episode 18: Traumatic Brain Injury