Management of Traumatic Brain Injury

1. Management of
Traumatic Brain Injury
Ade Wijaya, MD – June 2019

2. Pathophysiology

3. Secondary Brain Injury
Intracranial
• Expanding contusion/hematoma
• Cerebral edema
• Vascular injury/carotid dissection
• Seizures
• Hydrocephalus
• Vasospasm
• Pneumocephalus
• Intracranial infection
Extracranial
• Hypotension
• Hypoxia
• Hypo or Hypercapnia
• Pyrexia
• Coagulopathy
• Hypo or hyperglycemia
• Anemia
• Sepsis

5. Acute Brain Herniation

8. Key Points
1. The management of traumatic brain injury (TBI) has increasingly become more tailored to the
individual patient; measuring adequacy of cerebral oxygenation may allow lower cerebral perfusion
pressures to be targeted and more rational adjustments of PaCO2 levels.
2. Patients with TBI who are hypothermic at presentation should not be rapidly rewarmed.
3. Hypertonic saline can be a useful alternative to mannitol in the management of intracranial
hypertension.
4. Steroids are not currently recommended in the management of TBI.
5. Recombinant Factor VIIa may be useful in cases where correction of acidosis and hypothermia and
administration of appropriate blood products has failed to control continued nonsurgical bleeding.
6. Decompressive craniectomy is a useful therapeutic maneuver in selected cases of refractory
intracranial hypertension.