Re: ECC questions

Doolally — Sat, 14 Aug 2010 22:59:42 GMT

Thanks for typing that out Nick, definitely helps

Re: ECC questions

Nick Shackleton — Sat, 14 Aug 2010 22:50:20 GMT

Just been reading some ECC notes I've got

Fentanyl is prob the best to use in head trauma as it preserves cerebral blood flow and is thought to provide reliable analgesia without compromising intra cranial pressure

Also don't forget the use of ketamine as pain relief this can either be given as a bolus or constant rate infusion.

Always think multi-modal so using different classes of drugs to treat the pain.

Patients with severe brain injury should be kept normovolaemic. In the past it was advised to keep patients 'dry'. this has been disregarded as there is significant risk of both hypotensive episodes (leading to a fall in cerebral perfusion) and systemic inflammatory response syndrome (SIRS) or multiple organ failure (MOF) leading to failure of oxygenation and ventilation. Dehydration has little effect on cerebral oedema.

dextrose solutions should NOT be administered. These increase the water content of brain tissue. Elevated blood sugar levels are associated with a worsening of neurologic injury after episodes of global cerebral ischaemia.

Hypertonic solutions and osmotic diuretics such as mannitol will have the opposite effect. This needs an intact blood brain barrier. If this is damaged, as may be the case following injury. In this case mannitol may have no effect in reducing brain water content, and maintenance of the osmotic pressure in the vessels by administration of colloids, plasma proteins or other high molecular weight compounds may, theoretically, be of benefit. However in practice, colloids offer little benefit over crystalloid solutions.

There is no single best fluid for patients with traumatic brain injury, but isotonic crystalloids are widely used and have good scientific basis. Normal saline or lactated RInger's solution should be the standard resuscitation fluid until further studies show a clear benefit from other therapies. Regardless of the fluid type chosen, normovolaemia must be maintained and episodes of hypotension avoided.

Have to say this ain't all my own words. Taken from ECC notes I've got. hope it helps answers a few questions