The Basics: TBI Management

Prolonged Field Care Podcast

Dr. Van Wyk discusses updates in traumatic brain injury (TBI) management, focusing on the CRASH 3 trial and the use of tranexamic acid (TXA). He explains that TXA is safe and reduces head injury-related death, particularly in patients with moderate and mild TBI. He also discusses the use of hypertonic saline and recommends considering higher concentrations, such as 23.4%, which have been shown to be safe and effective. Dr. Van Wyk mentions the use of sodium bicarbonate as an alternative and emphasizes the importance of clinical judgment in determining the appropriate treatment. He also discusses monitoring options for cerebral edema and increased intracranial pressure, such as optic nerve sheath diameter measurements. Finally, he touches on the topic of decompressive hemicraniectomy and the considerations for performing this procedure in austere environments.

Takeaways

Tranexamic acid (TXA) is safe and reduces head injury-related death in patients with moderate and mild traumatic brain injury (TBI).

Higher concentrations of hypertonic saline, such as 23.4%, may be considered as they have been shown to be safe and effective.

Sodium bicarbonate can be used as an alternative to hypertonic saline, particularly in austere environments.

Optic nerve sheath diameter measurements can be used to monitor cerebral edema and increased intracranial pressure.

Decompressive hemicraniectomy may be considered in severe TBI cases, and general surgeons may be trained to perform the procedure in the absence of a neurosurgeon.

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