Traumatic Brain Injury (TBI)

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

Non-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.

Complications and Referral Criteria

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