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Tue Feb 20 18:22:45 GMT 2007

Just out of curiosity, wondered if any progress has been made with regard to
the roles of magnesium or Na-channel blockers in treating TBI (esp. diffuse
axonal injury) & preventing secondary axotomy?  I haven't done a lit. search
in a long time, & I no longer have access to journals.

Brian

On 2/20/07, Bjorn, Pret <pbjorn at emh.org> wrote:
>
> 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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