MedBalans

Traumatic Brain Injury

Adults · emergency only · brief protocol

Algorithm

  1. ATLS approach; assume cervical spine injury until cleared.
  2. Prevent secondary injury: maintain SpO₂ >94%, SBP >90 mmHg; avoid hypoxia/hypotension.
  3. GCS assessment; CT head if GCS <15, focal signs, vomiting, anticoagulation, or mechanism.
  4. Mannitol 20% 0.25–1 g/kg or hypertonic saline for raised ICP signs.
  5. Neurosurgical consult for mass lesion, depressed skull fracture, deteriorating GCS.
  6. Avoid unnecessary hyperventilation (target PaCO₂ 35–40 mmHg only if herniation).

Red flags

  • • Declining GCS, unequal pupils, or signs of herniation
  • • Anticoagulation / dual antiplatelet — reverse per local protocol
  • • Cervical spine protection until cleared

Medications by step

Step 1 — ICP management

  • Mannitol · i.v.

    0.25–1 g/kg IV over 15 min

  • Hypertonic saline 3% · i.v.

    250 mL IV bolus

Step 2 — Seizure prophylaxis

  • Levetiracetam · i.v.

    500 mg IV BID (first 7 days if indicated)

References

  • • Brain Trauma Foundation — TBI guidelines (2022)

Updated: Июль 2026