Traumatic Brain Injury (TBI)

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Clinical Description

Traumatic Brain Injury is divided into mild (GCS 14-15), moderate (GCS 13-9) and severe (GCS 8-3). This includes conditions like concussion, alteration of consciousness (confusion, amnesia +/- LOC) without structural damage because of non-penetrating TBI.

TreatmentNON-PHARMACOLOGICAL

  • ABCD + adequate resuscitation
  • Avoid hypoxia, hypotension (SBP >90mmhg)
  • Neuro assessment
  • If low risk for intracranial injury (ICI)
    • Can go for home observation with instructions
  • If moderate risk ICI
  • Do SXR, CT scan if available
  • Can go for home observation
  • If patient does not meet home observation, admit overnight
  • If high risk ICI
    • Admit
    • Elevate head of bed
    • Neuro checks 2-4 hrly
    • Keep NPO until alert, then clear liquids and advance as tolerated
    • Isotonic IV fluids, Normal Salani + 20mEq Potassium Chloride/L as maintenance (= 100cc/hr for average adult)
    • Mild analgesia; Paracetamol (and diclofenac IM if necessary)     
    • Do not give mannitol unless it is indicated.
    • Do not give anti-seizure prophylaxis unless indicated.

Referral 

  • Refer all (GCS <13) moderate and severe TBI to tertiary health care facilities.