Tactical Evacuation Care Guidelines Read text 6. Traumatic Injury b. Unilateral pupillary dilation accompanied Rising ICP may lead to cerebral herniation. When signs of herniation by a decreased level of consciousness may are present in a brain-injured casualty, rapid reduction is the ICP is signify impending cerebral herniation; if needed. these signs occur, take the following actions to decrease intracranial pressure: Hypertonic saline may help decrease ICP and improve cerebral perfusion pressure and brain tissue oxygen levels. Administer 250cc of 3% or 5% hypertonic saline bolus Elevation of the casualty’s head may help reduce ICP. Elevate the casualty’s head 30 degrees Continued… Read text Tactical Evacuation Care Guidelines Hyperventilation leads to reduced levels of CO2 in the blood that, in 6. Traumatic Brain Injury turn, can contribute to cerebral vasoconstriction and lowered ICP. b. (Continued) Therefore, hyperventilation can be used as a temporary measure to lower ICP in brain-injured casualties exhibiting signs of cerebral 3) Hyperventilate the casualty herniation. If capnography is available, it should be used to monitor Respiratory rate 20 end-tidal CO2 levels. The target range for CO2 is slightly lower than Capnography should be used to normal. maintain the end-tidal CO2 between 30-35 mmHg Hyperoxia also contributes to cerebral vasoconstriction that will The highest concentration of reduce cerebral blood flow which may help reduce elevated ICP. oxygen (FIO2) possible should be However, because of the increased amount of oxygen carried by the used for hyperventilation blood when hyperoxic, it will improve cerebral tissue oxygenation even while reducing cerebral blood flow. If oxygen is available, the Continued… highest concentration that can be delivered should be delivered. Tactical Evacuation Care Guidelines Read text 6. Traumatic Brain Injury The hypocarbia and cerebral vasoconstriction that result from Notes: hyperventilation may be harmful to a brain-injured casualty who is Do not hyperventilate unless signs of not herniating. These casualties need to maintain their cerebral impending herniation are present. perfusion. Accordingly, hyperventilation should only be used in casualties who display signs of cerebral herniation, and who need Casualties may be hyperventilated with emergent reduction in ICP. oxygen using the bag-valve-mask technique.
Tactical Evacuation Care Guidelines 6. Traumatic Injury b. Unilateral pupillary dilation accompanied by a decreased level of consciousness may signify impending cerebral herniation; if these signs occur, take the following actions to decrease intracranial pressure: Administer 250cc of 3% or 5% hypertonic saline bolus Elevate the casualty’s head 30 degrees Continued… Read text Rising ICP may lead to cerebral herniation. When signs of herniation are present in a brain-injured casualty, rapid reduction is the ICP is needed. Hypertonic saline may help decrease ICP and improve cerebral perfusion pressure and brain tissue oxygen levels. Elevation of the casualty’s head may help reduce ICP. Tactical Evacuation Care Guidelines 6. Traumatic Brain Injury b. (Continued) 3) Hyperventilate the casualty Respiratory rate 20 Capnography should be used to maintain the end-tidal CO2 between 30-35 mmHg The highest concentration of oxygen (FIO2) possible should be used for hyperventilation Continued… Read text Hyperventilation leads to reduced levels of CO2 in the blood that, in turn, can contribute to cerebral vasoconstriction and lowered ICP. Therefore, hyperventilation can be used as a temporary measure to lower ICP in brain-injured casualties exhibiting signs of cerebral herniation. If capnography is available, it should be used to monitor end-tidal CO2 levels. The target range for CO2 is slightly lower than normal. Hyperoxia also contributes to cerebral vasoconstriction that will reduce cerebral blood flow which may help reduce elevated ICP. However, because of the increased amount of oxygen carried by the blood when hyperoxic, it will improve cerebral tissue oxygenation even while reducing cerebral blood flow. If oxygen is available, the highest concentration that can be delivered should be delivered. Tactical Evacuation Care Guidelines 6. Traumatic Brain Injury Notes: Do not hyperventilate unless signs of impending herniation are present. Casualties may be hyperventilated with oxygen using the bag-valve-mask technique. Read text The hypocarbia and cerebral vasoconstriction that result from hyperventilation may be harmful to a brain-injured casualty who is not herniating. These casualties need to maintain their cerebral perfusion. Accordingly, hyperventilation should only be used in casualties who display signs of cerebral herniation, and who need emergent reduction in ICP.
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