Lady, fell and went boom?

[Mateo_1387]

I do not remember saying it, but thanks for posting the scenario.

Just out of curiosity, when you did the DAI, did you use 100mg of lidocaine?

As for the BP on the herniation patient, the information I have is from the 5th edition BTLS book by Dr. John Campbell.

In the book, he says (I am paraphrasing), that a traumatic brain injury (TBI) rarely present with hypotension. When hypotension is present, it is usually caused by hemorrhagic or neurogenic shock. According to Dr. Campbell, the TBI patient cannot tolerate hypotension. Farther, an instance of hypotension, meaning a systolic pressure below 90, can increase the mortality rate by 150%. Hypotension in children with a TBI has an even higher mortality rate. Dr. Campbell recommends that the pressure be kept between 110-120 systolic, and the Cerebral Perfusion Pressure (CPP) be kept above 60mmHg.

[fireflymedic]

+2 kaisu !

[VentMedic]

The other thing that is useful with a patient with increasing ICP is hyperventilation. Blowing off the CO[sub:2d81b5351d]2[/sub:2d81b5351d] is helpful to reduce swelling. This is another balancing act as the trick is to keep partial pressure of CO[sub:2d81b5351d]2[/sub:2d81b5351d] around 40 - too low and you risk hypoxia.

Maintaining an SpO2 (hopefully = to SaO2) of >/ 90% will give you a PaO2 of 60 mmHg which prevents hypoxia.

Maintaining an ETCO2 (hopefully correlates with PaCO2 if no shunting or V/Q mismatching) of 32 - 40 mmHg provides some vasoconstiction. A PaCO2 of below 30 mmHg risks hypoperfusion of the brain. The exception being if you have another noted state of acidosis....which you probably won't in the field.

[CBEMT]

How'd the carry go?

[Kaisu]

VentMedic - you are so d*** smart! Thank you for the continuing ed.