Traumatic Brain Injury

Synonyms and related terms:

Head trauma a.k.a. head injury a.k.a. traumatic brain injury TBI


With or without neuroimaging: CT more commonly than MRI,

Classification, the Glasgow coma scale GCS was designed for this:

Mild: GCS 13-15
Moderate: GCS 9-12
Severe: GCS = or <8
Critical: GCS 3-4


If mild:

  • Consider discharge or observation

ABCD drill (Airway, Breathing, Circulation, Deficits)
Treat surgically correctible lesions
If not mild, consider prophylactic antiepileptic drugs:

  • Phenytoin PHT or levetiracetam, only for 1 week
  • If open skull fracture or Gun shot wound, consider 3 months prophylaxis

In severe trauma:

  • ICP monitoring if abnormal CT or high risk
  • Keep cerebral perfusion pressure CPP  >50 mmHg, but avoid >70 mmHg by:
    • Cerebral perfusion pressure CPP= mean arterial pressure MAP – intracranial pressure ICP
    • Noradrenaline I.V. infusion
    • Fluids: Saline. Avoid albumin. [SAFE]
    • Corticosteroids should not be used routinely

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