Surgery & Traumatology
Traumatic brain, facial & spinal cord injuries
Traumatic brain injury (TBI) management involves a systematic approach to optimize outcomes. Severe TBI requires advanced monitoring, targeted therapies, and surgical interventions like decompressive craniectomy to manage intracranial pressure (ICP) and prevent secondary brain injury. Imaging evaluation is crucial for diagnosing and guiding treatment decisions, with advanced techniques like diffusion-weighted imaging (DWI) aiding in early diagnosis. Intracranial hypertension management algorithms integrate ICP and brain oxygen monitoring to optimize cerebral perfusion and oxygenation.
Traumatic spinal cord injury (SCI) in polytrauma patients necessitates specialized care to prevent secondary injuries. Early stabilization, hemodynamic support, and complication management are essential, along with neuroprotective therapies and rehabilitation to enhance recovery.
Facial fractures require accurate classification and detailed imaging for effective treatment planning. Structured radiological reports guide clinical management, while nursing interventions focus on pain management, airway maintenance, and patient education to support recovery and rehabilitation.
Traumatic brain injury
Severe traumatic brain injury
Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
Nancy Carney et al., Neurosurgery (2017)
What’s inside
The fourth edition of these guidelines provides evidence-based recommendations for the management of severe traumatic brain injury (TBI), focusing on optimizing outcomes through standardized care.
Why it’s relevant
Severe TBI is a leading cause of death and disability, requiring timely and effective interventions to minimize long-term consequences.
Key focus
- Monitoring and management of intracranial pressure (ICP)
- Use of hyperosmolar therapy (e.g., mannitol, hypertonic saline)
- Strategies for preventing secondary brain injury
- Recommendations for surgical interventions and decompressive craniectomy
Takeaway
The guidelines emphasize a systematic approach to severe TBI management, integrating advanced monitoring, targeted therapies, and surgical interventions to improve patient outcomes.
Severe traumatic brain injury
The Management of Traumatic Brain Injury
American College of Surgeons (2024)
What’s inside
These guidelines provide a detailed guide on the management of traumatic brain injury (TBI), focusing on best practices for trauma centers. It includes recommendations for assessment, triage, treatment, and postacute care, as well as strategies for integrating these practices into clinical workflows.
Why it’s relevant
Effective management of TBI is crucial for minimizing long-term disability and improving patient outcomes. These guidelines help healthcare providers in trauma centers standardize care and enhance treatment processes for TBI patients.
Key focus
- Assessment and triage procedures for suspected TBI
- Guidelines for managing intracranial pressure (ICP), ventilation, and nutrition in TBI patients
- Performance improvement strategies, including monitoring and outcome measurement
- Implementation of TBI best practices at trauma centers through gap analysis and interdisciplinary education
Takeaway
The document emphasizes the importance of adopting evidence-based guidelines and integrating them into trauma center practices to improve outcomes for TBI patients. Interdisciplinary collaboration, continuous monitoring, and ongoing education are critical to success .
Traumatic brain injury | imaging
Imaging Evaluation of Acute Traumatic Brain Injury
Christopher A. Mutch et al., Neurosurgery Clinics of North America (2016)
What’s inside
This article reviews the imaging evaluation of acute traumatic brain injury (TBI), focusing on the role of advanced imaging techniques in diagnosis and management.
Why it’s relevant
Accurate imaging is critical for diagnosing TBI, guiding treatment decisions, and predicting outcomes in patients with acute brain injuries.
Key focus
- Role of CT and MRI in detecting intracranial injuries
- Advanced imaging techniques, including diffusion-weighted imaging (DWI) and perfusion imaging
- Imaging findings in specific TBI patterns (e.g., contusions, diffuse axonal injury)
- Use of imaging to guide surgical and non-surgical management
Takeaway
The article highlights the importance of advanced imaging in the early diagnosis and management of acute TBI, enabling tailored interventions to improve patient outcomes.
Intracranial hypertension
Intracranial pressure monitoring
A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)
Gregory W J Hawryluk et al., Neurosurgery (2020)
What’s inside
This article presents a management algorithm for patients requiring intracranial pressure (ICP) monitoring, developed by the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). It provides evidence-based recommendations for managing patients with severe traumatic brain injury (TBI) and elevated ICP.
Why it’s relevant
ICP monitoring is a critical component in managing severe TBI in the ICU. This algorithm guides ICU professionals through decision-making processes, optimizing patient outcomes by addressing elevated ICP and related complications.
Key focus
- Step-by-step management algorithm for ICP monitoring
- Pharmacologic and surgical interventions for elevated ICP
- Indications for invasive monitoring and when to escalate care
- Multidisciplinary approach for optimal patient management
Takeaway
This article provides a structured management approach for ICU professionals handling patients with severe TBI and elevated ICP, offering evidence-based strategies to improve patient care and outcomes.
Brain oxygen and intracranial pressure monitoring
A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)
Randall Chesnut et al., Intensive Care Medicine (2020)
What’s inside
This article outlines a management algorithm for adult patients requiring both brain oxygen (PbrO2) and intracranial pressure (ICP) monitoring, developed by the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). It provides evidence-based recommendations for managing severe traumatic brain injury (TBI) in ICU settings.
Why it’s relevant
Monitoring both ICP and brain oxygen levels is crucial for optimizing care in patients with severe TBI. This algorithm helps ICU professionals navigate complex decision-making, balancing interventions to improve brain health and prevent secondary brain injury.
Key focus
- Management algorithm combining PbrO2 and ICP monitoring
- Pharmacologic, surgical, and supportive interventions
- Indications for escalating care based on monitoring parameters
- Optimizing cerebral perfusion and oxygenation
Takeaway
This article provides a structured approach for ICU professionals managing patients with severe TBI, offering a comprehensive strategy for monitoring and treating ICP and brain oxygen levels to improve outcomes.
Decompressive craniectomy
Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations
Gregory W J Hawryluk et al., Neurosurgery (2020)
What’s inside
This 2020 update focuses on the role of decompressive craniectomy (DC) in the management of severe traumatic brain injury (TBI), providing revised evidence-based recommendations.
Why it’s relevant
Decompressive craniectomy is a critical intervention for reducing intracranial pressure (ICP) in severe TBI, but its use requires careful consideration of risks and benefits.
Key focus
- Indications and timing for decompressive craniectomy
- Comparison of primary vs. secondary DC
- Outcomes and complications associated with DC
- Recommendations for patient selection and post-operative care
Takeaway
The update emphasizes a cautious, evidence-based approach to decompressive craniectomy, balancing its potential benefits in reducing ICP with the risks of complications and long-term outcomes.
Traumatic spinal cord injury
Traumatic spinal cord injury
Update on critical care for acute spinal cord injury in the setting of polytrauma
John K. Yue et al., Neurosurgical Focus (2017)
What’s inside
This article provides an update on the critical care management of acute spinal cord injury (SCI) in polytrauma patients, focusing on evidence-based strategies to optimize outcomes.
Why it’s relevant
Acute SCI in polytrauma patients presents unique challenges, requiring specialized care to prevent secondary injuries and improve recovery.
Key focus
- Early stabilization and surgical management of SCI
- Hemodynamic and respiratory support strategies
- Prevention and management of complications (e.g., infections, thromboembolism)
- Role of neuroprotective therapies and rehabilitation
Takeaway
The article highlights the importance of a multidisciplinary approach to managing acute SCI in polytrauma patients, integrating early interventions, supportive care, and rehabilitation to enhance recovery.
Facial fractures
Facial fractures
Facial fractures: classification and highlights for a useful report
Eva Gómez Roselló et al., Insights into Imaging (2020)
What’s inside
This article provides a comprehensive classification of facial fractures and highlights key elements for creating a useful radiological report to guide clinical management.
Why it’s relevant
Accurate classification and reporting of facial fractures are essential for effective treatment planning and improving patient outcomes.
Key focus
- Classification of facial fractures by anatomical region (e.g., mandible, maxilla, orbit)
- Imaging modalities for diagnosing facial fractures (e.g., CT, 3D reconstruction)
- Essential components of a radiological report for facial fractures
- Clinical implications of fracture patterns and associated injuries
Takeaway
The article emphasizes the importance of detailed imaging and structured reporting to ensure accurate diagnosis and optimal management of facial fractures.
Facial fractures
What you need to know about facial fractures
Michael W. Day et al., Nursing (2006)
What’s inside
This article provides an overview of facial fractures, focusing on their causes, clinical presentation, and nursing considerations for patient care.
Why it’s relevant
Facial fractures are common in trauma patients and require prompt recognition and appropriate management to prevent complications and ensure optimal recovery.
Key focus
- Common causes and mechanisms of facial fractures
- Clinical signs and symptoms of facial fractures
- Nursing interventions for pain management and airway maintenance
- Importance of patient education and follow-up care
Takeaway
The article highlights the critical role of nurses in recognizing facial fractures, providing immediate care, and supporting patients through recovery and rehabilitation.