Brain Injury, Traumatic

Incidence in USA: 1.7 million TBIs per year as of 2010, resulting in more than 280,000 hospitalizations and over 50,000 deaths.

TBI is responsible for about 30% of all deaths due to injury.

TBI, primarily from falls, has increased more than 50% in geriatrics from 2001 to 2010.

Brain herniation

Coagulopathy, DIC

Metabolic derangement

Occult cervical spine injury

Other preexisting medical conditions

Neurogenic pulm edema

Subclinical seizures

TBI is a major cause of death and disability with increasing rates among senior citizens.

Care is focused on avoiding secondary injury to the brain.

Normal saline without glucose should be used instead of colloid or albumin. Hypertonic saline can be used with appropriate caution.

Brief moments of hypocapnia may occur to urgently lower ICP, otherwise normocapnia.

Avoid hyperthermia. There is no consensus on therapeutic hypothermia.

Antiseizure prophylaxis with phenytoin to levetiracetam for high-risk pts.

External trauma causing brain contusion, laceration, diffuse axonal, injury, or hematoma.

Spontaneous bleeding from cerebral vessels may occur, subarachnoid or intracerebral.

GCS ≤8 is severe TBI; 9 ≤GCS ≤12 is moderate TBI.