Dave McCreary Talks About management of severe traumatic brain injury.

1. Intracranial Pressure
Management in Severe TBI
Dave McCreary

2. A bit of a refresher on ICP
ICP Monitoring
Severe head injury management
When the S**t hits the fan

5. CPP = MAP - ICP

6. CPP 55 – 95 mmHg
MAP > 80 mmHg
ICP < 20 mmHg

8. Widened Pulse Pressure
Irregular Breathing
Bradycardia

11. Brain Trauma Foundation
Guidelines
All salvageable patients with sTBI and abnormal
CTB (LEVEL II)
Patients with sTBI and NORMAL CTB with ≥ 2 of:
• Age >40
• Uni/Bilateral motor posturing
• SBP < 90mmHg
(LEVEL III)

16. Sats >95%
ETCO2 35-40 mmHg
PEEP <12

18. 90 < SBP < 160 mmHg
80 ≤ MAP <110mmHg
Hb >100

21. What about when it hits the fan?
Blown Pupil(s)
Actual / impending herniation
Progressive Hypertension
(>160) & Bradycardia (<60)

22. 15-30 mins at ETCO2 30-35 mmHg

23. 6ml/kg 5% Saline (Max 350ml)

24. Decompressive craniectomy
When death is imminent due to intracranial hypertension

25. braintrauma.org
trauma.org