Hospitals & Services
Diffuse TBI: GCS < 9 and scan swelling
OR GCS > 9 pre intubation + severe CT swelling (Grade DIII or IV)
<72 hrs since accident
Arterial line and CVP
IV Fluid to CVP 8-12
Noradrenaline infusion to MAP > 90 mmHg until ICP inserted
Serum Na 140 - 155 mmol/L
Maintain BSL to CVP mmol/L and Hb close to 10
Cool to 37°C
Only after discussion with the Duty Intensive Care specialist
CPP = MAP – ICP
ICP monitoring: EVD or parenchymal catheter acceptable
EVD at 20cm – intermittent drainage prn (monitor for 10', drain for 5')
Noradrenaline and/or adrenaline infusion to maintain CPP > 60 mmHg for 1st
If serum osmo < 315mosm/L & CVP < 12
If serum osmo < 315 & CVP > 12
Pancuronium 4-8 mg IV
If ICP then controlled, increase sedation
If ICP > 20mmHg for 4 hours or > 30 mmHg for 1 hour consider: only after discussion with the duty Intensive Care Specialist:
Thiopentone 4 mg/Kg bolus
If repeated boluses fail to control ICP, then use Thiopentone infusion at 100 mg/hour.
If ICP still uncontrolled, consider á Thiopentone to burst suppression using EEG.
Cease Thiopentone when ICP controlled <20mmHg for 24 hour.