Brain Oedema due to Traumatic Injury

Clinical Description

General/ Measures

• Refer patient for neurosurgical opinion, if indicated. Supportive management.

Rehabilitation intervention.

Note: DVT prophylaxis with heparin may be contraindicated owing to risk of increased bleeding.

• The following measures should be used in patients with raised intracranial pressure:
• head elevation and position,
• airway and ventilation control,
• sedation and analgesia,
• control of fever,
• control of hypertension, and
• prevention of seizures.
• Currently, no evidence supports the use of hyperventilation in this setting.

Treatment

• For raised intracranial pressure, pending neurosurgical procedure only:
• Give Mannitol 15-25%, IV, 0.25-1 g/kg administered over 30-60 minutes.

Monitor neurological response and urine output. Do not repeat more than 6-8 hourly.

• Beware of hypovolaemia and electrolyte disturbances, especially hypokalaemia.

Currently no evidence exists to support the use of hypertonic saline infusion.

Corticosteroids used in this setting have a harmful effect

For prevention of seizures:

• Phenobarbital (loading dose 15-20mg/kg [max 1.2g] IV infused at 25 – 100mg/min [beware of respiratory depression at maximum dose]; maintenance dose 1- 3mg/kg/day PO/IV in 1 or 2 divided doses).
• Phenytoin (loading dose 15 – 20mg/kg [max 2g] IV at 25mg/min slow IV push [Do not exceed 50mg/min]; maintenance 300 – 400mg/day)