10 Things You Need To Know About TBI with Dr. Knight

TBI is a heterogenous disease entity for which we do not have a lot of solutions. The one piece of level one evidence in TBI: Do not give steroids. As for the rest, well, here's the top ten things you should know according to Dr. Knight:

10. Mechanical Support. Don't forget the easy stuff: Don’t make the C collar too tight, keep head in midline and upright, HOB @ 30 degrees.

9. Anticoagulation reversal. If they need to be reversed, reverse them.

8. AnalgoSedation. Treat them adequately as pain increases ICP and TBI is painful. Ketamine is probably safe and likely does not increase ICPs significantly.

7. Avoid Extremes. Maintain normothermia, normo-glycemic, normal BP, normal HR, etc

6. Do things EARLY. Get them eating, walking, trach/PEG and closer to normalcy as early as you can.

5. Mechanical Ventilation in the ED. What we do matters downstairs and has repurcussions for treatment upstairs. Do not hyperventilate and give appropriate tidal volumes.

4. Monitoring. Continuous EEG, EVDs, Licox etc. These are important to guide management but are not management within themselves. Know the importance of the information you are getting and integrate it within the context of the patient.

3. Surgical Management. Rely on our colleagues to determine when and who to go.

2. Early aggressive care. In the ED Our job is to be aggressive, not to prognosticate. Avoid self-fulfilling prophecies and see GSW to the Head above.

1. There is no number one. Yet. Some day there will be a number 1 that ups our game in the treatment of TBI. But we haven't found it yet.