1. Brain Trauma: Translating the Guidelines to Practice Presented by: Mary Kay Bader RN, MSN, CCNS Neuro/Critical Care CNS Mission Hospital [email_address]

2. The Main Subject: BTF Guidelines Surgical Guidelines 2006

3. Facilitating Implementation: What does it take?

10. Pathological Changes Secondary Injury Coordinated ICU Multidisciplinary Care Critical Care Management of Severe TBI Evidence Based Practice Dynamics of Injury & Monitoring Technologies

17. Severe TBI Patient: GCS 3-8 CT+ Injury Arrival: Emergency Department Trauma Bay Assess A-B-C: Oxygenation and Ventilation Airway: Secured with RSI Breathing: Connect to Ventilator Avoid hyperventilation Use Capnography to monitor ET CO2 Assess Circulation: Assess Pulse, ECG and BP IV fluids to maintain adequate MAP

18. Translational Practice: Implementing the Guidelines Treatment of ICP should be initiated with ICP > 20 mm Hg Combination of ICP, clinical & Brain CT findings should determine need for Tx

20. Severe TBI Patient: GCS 3-8 CT+ Injury Diagnostic Tests, Insertion of Monitoring Devices & OR Radiographic Evaluation –Confirmation Placement of ICP/Ancillary Monitoring Operative Intervention Needed Surgical Guidelines

21. Severe TBI Patient: GCS 3-8 CT+ Injury Surgery

22. Severe TBI Patient: GCS 3-8 CT+ Injury Surgery

23. Translational Practice: Implementing the Guidelines ICU Care

24. Severe TBI Patient: GCS 3-8 CT+ Injury ICU Care: Primary Interventions Admit to ICU A & B: Oxygenation/Ventilation Optimization Circulation: Maintain CPP 50-60 mm Hg as initial target Autoregulation Testing: Intact – may need CPP up to 70 mm Hg ICP Management : Draining CSF and Providing Sedation/Analgesia

25. Translational Practice: Implementing the Guidelines ICU Care

26. Translational Practice: Implementing the Guidelines ICU Care DON’T USE THEM

27. Translational Practice: Implementing the Guidelines Tertiary Interventions

28. Translational Practice: Implementing the Guidelines Tertiary Interventions Recent Research

29. Latest Conversations on Hypothermia in TBI

32. Should Normothermia be considered part of the Core Interventions of TBI?

33. Putting It All Together

52. Choice of Analgesia and Vasopressor Use in Severe TBI

53. Change of Sedation Approach

54. Change of Sedation Approach

55. Case Application

57. Admit CT scan TO OR

61. Days 1-3

62. Day 4

65. Rewarm and the Lungs

66. Recool x 7 days

67. Day 7

69. ARDS Lungs worsen while on Barbs/Hypothemia: Nitric Oxide x 12 days Decision to Prone

71. Book on Adam’s Story