Traumatic Brain Injury (TBI)

Tom RaderStaff - June 1, 2021

Head Trauma Head trauma is a simple problem. It is JUST trauma to the patient’s head with NO changes to mental status. This can take the form of a cut
[See the full post at: Traumatic Brain Injury (TBI)]

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Is acetaminophen OK for someone with a TBI, as it doesn’t have the same bleeding risks as aspirin/ibuprofen?

 

Generally yes. I’ve updated text. It’s a tricky legal line for us to talk about which specifics meds to use…

 

>There is an old myth that you cannot let a person with a TBI go to sleep. This myth is absolutely false.

Thank you for addressing this specifically. Perhaps it would be worth adding a reference? I’m not sure of a good one. I found:

• https://www.whhs.com/BAHT/Injury-and-Rehabilitation.aspx
• https://www.bbc.com/future/article/20160616-should-you-let-someone-with-concussion-fall-asleep

>Try and push calories as a liquid as possible

Should this say “if possible”?

The tips in this video are good. It makes me feel like each lesson should have a summary section at the top, with bullet points for people who need quick reference. e.g. “Monitor for 24 hours. Sleeping okay. Keep hydrated and warm.” What do you think about doing that for this and some of the other lessons? Is this course intended to be used as a quick reference? Or more like training, supplemented by some hardcopy first aid reference?

 

Sources added. 

Once the course has “baked” a little bit more / more people have touched it and given feedback, I would like to go back through and add quick actionable references that would help if someone is in an actual emergency and looking up info. For now, we wanted to start with the more standard classroom-type training + they have their field reference book (like the one shown in the gear/IFAK packing lessons).

 

Whats an average timeline for TBI to go from “probably ok staying at home” to “hospital…now”? You said it depends on the severity and symptoms so do you have a time range? does it happen in minutes? hours? a day? all the above?

 

The risk window is 24 hours, since that’s how long it can take for swelling to peak. It seems logical though that the majority of swelling cases reach their peak quicker than that, with the concern threshold likely being crossed in < 12. So I’m going to flag this question for the guys who’ve seen thousands of patients to see if they’ve noticed any patterns, eg. most “this is serious” decisions/thresholds happen within 6 hours of injury.

 

Another good question.

I would recommend using your entire patient assessment findings and any trends found during continued ongoing assessments to determine the possible severity of a TBI rather than a set timeframe.  Again, several variables need to be considered.  

 

@Lone Star: In your personal experience, have you noticed a pattern / rule of thumb such as “the vast majority of TBIs are noticeable as TBIs within X hours of trauma”? We know the broadly-correct advice of 24 hours and how there are tons of variables that go into it… just wondering about patterns.

 

Can I get away with saying, the pattern is there are no patterns?”   lol/but half serious 

 

If the individual has a significant headache after a TBI that doesn’t go away but also isn’t worsening or being accompanied by altered mental status or vomiting etc. should they still be assumed to have ICP? Just curious how to differentiate between the pain of a hit to the head causing a headache versus ICP causing a headache. Or perhaps TBI headaches (lasting more than a few hours) only occur in patients with ICP?

 

If the individual has a significant headache after a TBI that doesn’t go away but also isn’t worsening or being accompanied by altered mental status or vomiting etc. should they still be assumed to have ICP?

My understand is, no, you wouldn’t assume ICP. Since it’s hard to know what’s going on inside the head, that’s why the patient needs to be monitored for the first 24 hours, so you can catch the changes/signals that it’s more than ‘just a headache.’ Watching for those changes over time is about the only thing you can do in an austere setting.

If it’s been more than a day and the consistent headache hasn’t gotten better, even though there have been no other signs like vomiting or confusion, at that point I’d want to get medical attention if reasonable.

Context can matter though. eg. If you know the patient took major trauma to the head, like smashing their head in a car accident, you’d err more on the side of caution / assuming they have an ICP until you come to believe they don’t, even if the patient is saying “oh it’s just a headache.”