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Wed Feb 21 15:46:41 GMT 2007

Although you may be coming at it from a new direction, I don't think
that anything you've learned changes the well-known priorities: Airway,
Breathing, Circulation, Disability...  

The emphasis on blood pressure is a reminder from our neurosurgery
colleagues that head-injured patients often have other major problems
that must be treated in order for the brain to stay lit:  CPP = MAP -
ICP.  Sadly, this equation is difficult to influence (much less
control), particularly in the prehospital phase.

The GCS is little more or less than a vital sign, and it's important to
note that it refers exclusively to parts which don't take well to
emergent exploratory surgery.  Use the GCS to triage patients to trauma
centers, and once there, to CT and neurosurgery.  Given that there are
many non-operable injuries causing coma, the GCS in isolation is a
frightfully oversensitive indication for operation.

Pret

-----Original Message-----
From: David Sullivan [mailto:fpcems at yahoo.com] 
Sent: Tuesday, February 20, 2007 3:14 PM
To: Bjorn, Pret; trauma-list at trauma.org
Subject: Re: Chestnut TBI Article

Pret, 

Kinda difficult to read b/c its rotated 180o, anyway no problem. This
course that I took related BP and Spo2, and the combination of the both
as predictors for outcome in pt taken to apprioate trauma centers. It
was interesting to note that pts that kept a SBP above 90, but had
moderate Spo2 below 90% had a 1/2 high mortalilty rate. we were told
that GCS whether improving or decreasing is the best indicator for
immediate crainotomy or ICP montoring...I know that SBP is important in
the ?TBI pt, but I didnt know it was that important, right up there with
Airway....any opinion?

"Bjorn, Pret" <pbjorn at emh.org> wrote:

	<<TBI_2.pdf>> <<TBI_1.pdf>> 

	Forwarded in two parts, as was delivered to me. 

	Let me know what you think.

	Pret

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