Trauma Guideline Manual - SUNY Upstate Medical University

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108____________ Trauma Guideline ManualUpstate Medial University Trauma Centerd) Start antibiotics
Trauma Guideline Manual______________Upstate Medical University Trauma Center109PRACTICE GUIDELINES: ICU MANAGEMENT OF TRAUMATIC BRAIN INJURY ANDCEREBRAL PERFUSION PRESSUREOBJECTIVES:NOTE: Upstate University Hospital Neuro-Critical Care,Trauma Surgery & Neurosurgerycurrently are developing a new collaborative and comprehensive management protocol.Be advised to check for revisions to the below guidelines as the new protocol rolls out.1. Define the brain injured patient that is at risk for “secondary injury.”2. Define guidelines for the prevention and management of secondary injury in the seriouslybrain injured patient.PATIENTS AT RISK FOR SECONDARY BRAIN INJURY:1. Brain injury associated with a GCS 250; maintain O 2 saturation >96%.b. Maintain pCO 2 35-40 mmHg.4. Consider an intracranial pressure monitor/ EVD & LICOX monitor for all patients with aGCS< 85. Consider an intracranial pressure monitor/ EVD & LICOX monitor for all patients with aGCS> 8 with significant Intracranial hemorrhage.6. Insert arterial line and CVL.7. Head of bed flat unless otherwise specified.8. Maintain sedationa. Propofol titrated to a RASS of 0.b. Narcotic gtt for continuous pain control.9. Treat fevers of >38.5.a. Cooling blanket.b. IV Tylenol
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