Category: Traumatic Brain Injury

Airway Management · Cervical Spine Injury · Traumatic Brain Injury

A Few Handy Resources on Airway Management

AC. FeylingLeave a comment

Patients with head- and neck injuries can have challenging airways. We often use videolaryngoscopes or flexible fibrescopes (single use scope) when performing intubation in such patients. Our colleagues in Copenhagen have put together a useful website with videos and other learning resources on that subject. They also arrange an annual  two-day airway course with a very extensive workshop. Read more… Continue reading A Few Handy Resources on Airway Management

Airway Management · Neurocritical Care · Neurotrauma · Traumatic Brain Injury

More Brain Impact Apnoea

AC. FeylingLeave a comment

Brain impact apnoea causes secondary brain injury.  The duration of the apnoea reflects the energy in the injury. We often see these patients in our trauma center as they come intubated. CT-scan can reveal structural brain damage or bleeding. In some pastients the CT-scan is “normal”. However, the brain may have suffered hypoxic injuries undetectable with… Continue reading More Brain Impact Apnoea

Neurocritical Care · Seizure Control · Thermoregulation

HYBERNATUS Trial: Hypothermia Not Associated With Better Outcomes in Status Epilepticus

andersfeyling2 Comments

Results from the HYBERNATUS trial were just published in the New England Journal of Medicine by Legriel et al. This study recruited 270 patients with convulsive status epilepticus, randomized to either therapeutic hypothermia (32-34 C) or normothermia. All patients were intubated and on controlled ventilation when included. All received standard antiepileptic pharmacological treatment. Primary outcome… Continue reading HYBERNATUS Trial: Hypothermia Not Associated With Better Outcomes in Status Epilepticus

Haemodynamics · TBI General · Traumatic Brain Injury

Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?

andersfeylingLeave a comment

It is widely accepted that hypotension in patients with traumatic brain injury is associated with poorer outcomes, as confirmed in a number of studies. But is there really a reliable cut-off for when we should be happy with a TBI patient´s blood pressure in a prehospital setting? A recent article in JAMA Surgery (Spaite et… Continue reading Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?

Decompressive Surgery · discussions · ICP/CPP management · TBI General · Traumatic Brain Injury

RESCUEicp Trial Results Finally Out: Craniectomy in TBI Lowers Mortality, But Survivors Suffer Worse Neurological Outcomes

andersfeyling2 Comments

After completing recruitment of some 408 TBI patients in 2014, the RESCUEicp group finally published the results from this eagerly awaited trial. The article by Hutchinson et al, titled Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, was published on September 7th in the New England Journal of Medicine. So let´s go straight to the core: The study… Continue reading RESCUEicp Trial Results Finally Out: Craniectomy in TBI Lowers Mortality, But Survivors Suffer Worse Neurological Outcomes

Airway Management · TBI General · Traumatic Brain Injury · Ventilation and Oxygenation

SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI

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In a recent article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine by Pakkanen et al, retrospective data from a Finnish prehospital service is presented. They looked at prehospital management of severe TBI (severe head injury with GCS 8 or lower) over a 6-year period, including some 458 patients for analysis. They found a… Continue reading SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · TBI General

To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

andersfeylingLeave a comment

There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score… Continue reading To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

ICP/CPP management · Neuroprotection · TBI General · Thermoregulation · Traumatic Brain Injury

Eurotherm 3235 Trial

andersfeyling3 Comments

The long-awaited Eurotherm trial was published in NEJM in autumn 2015. The premise of the study was to examine the impact of induced hypothermia on outcomes after traumatic brain injury. In a multi center randomized controlled trial patients were allocated to either therapeutic hypothermia (32-35 degrees) or the control group (standard care, normothermia). The study… Continue reading Eurotherm 3235 Trial