Operating Room:
In OR from ER: consider
ICP monitor if unstable. CT head prior
to OR if stable.
Correct coagulopathy intraop if necessary.
Will usually have HOB flat which may exacerbate ICH.
Simultaneous craniotomy and exlap may (rarely) be necessary.
Interventional Radiology
Limitations for ICP monitoring
during procedure.
Will have HOB flat which may exacerbate ICH.
High risk for TBI progression.
Chest Trauma
Analgesia clouds neuro exam.
Cardiac contusion
May need echo or PAC to ensure
CO/CPP.
MI/PE
May need anticoag if life-threatening MI or PE.
Need ICP monitor.
Aortic dissection
Beta blockers decrease CPP and may exacerbate TBI.
Though IR suites have limited monitoring, endografts may
require less long-term antiplatelet/anticoag meds.
Abdominal Compartment
Syndrome
Opening abdomen decreases ICP but multiple OR trips with
fluids/pressors/Lasix can exacerbate TBI.
Use paralytics early in these patients to reduce
intrathoracic pressure.
Long-bone fractures
Operate as soon as the risk of
exacerbating TBI is minimized.
Replace EBL and avoid shock.
Fat Emboli in up to 15% of TBI/Femur combos
Spinal cord Injury
Early fixation/fusion, but prone
position can exacerbate ICP so may need ICP monitor.
Frontal Sinus
Fix early if high CSF leak,
pneumocephalus, duct involvement, or significant TBI.
CSF Leaks
If from basilar skull fx (1/3)
then they usually close spontaneously.
Operate and/or Drainage if no
decrease in volume, leak is persistent, or meningitis.
Nonop tx:
·
See guideline for atbx (http://uktraumaprotocol.blogspot.com/2013/04/facial-fracture-antibiotic-guideline.html)
·
Bedrest with HOB 15-20
·
No caffeine.
·
No LP.
