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Tue Feb 20 14:41:08 GMT 2007

This from PubMed:
Chesnut RM.  Care of central nervous system injuries.  Surg Clin North
Am. 2007 Feb;87(1):119-56, vii.  
Department of Neurosurgery, University of Washington, Harborview Medical
Center, Box 359766, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
chesnutr at u.washington.edu
The primary method of improving outcome from traumatic brain injury is
through avoiding secondary insults to the injured brain. Although
surgery is important, most management is critical care. Evidence-based
guidelines continue to be developed to assist in directing care. With
modern monitoring systems, a physiologic-based approach is increasingly
applicable, allowing focused treatment for intracranial hypertension and
ischemia. It is important to balance and integrate the care of the
injured brain into the overall care of the polytrauma patient.
PMID: 17127126 [PubMed - indexed for MEDLINE]

Randy Chestnut is arguably among the top two or three contemporary
authorities in neurosurgery -- being polite and generous to the other
one or two, whomever they are.  These are recent and (apparently)
exhaustive recommendations.  I've asked for a copy from our medical
library.

As for the GCS (speaking from memory here, and grateful for any
corrections from the List): a score of three in the absence of exogenous
chemistry is a dismal prognostic finding, and I'm quite sure there are
correlates for morbidity, mortality, complication, and functional
return, right on up through the scale.  There are other scores and
scales available, and the GCS has its critics, but it can't be beat for
accessibility, inter-rater reliability, or broad recognition.  

As far as I am aware, while the GCS is prominent among the indications
for ICP monitoring, it is not so good at triage for craniotomy.  Think
about all the DAI we see.

Hope this helps, and I look forward to other replies.  This is good
stuff to review periodically.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of David Sullivan
Sent: Tuesday, February 20, 2007 8:34 AM
To: Trauma &amp, Critical Care mailing list
Subject: TBI/GCS

I took the TBI course yesterday and we learned about keeping a pt with
?TBI w/ a bp 90mm s, and a SpO2 of at least 90%, this information was
accurate as of 98, just wondering if there have been any changes to this
thought process, and is an early GCS score in field a helpful predictor
or pt outcome in the hospital? and whether or not this pt has
neurosurgery or not?

  Just trying to spark a convo

  dave sullivan BA NREMT-P

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