Prophylactic hypertonic use versus bolus rescue

In this episode of the PFC Podcast, Dr. Van Wyk discusses the latest updates in traumatic brain injury (TBI) management, focusing on insights from the CRASH-3 trial, the use of TXA, hypertonic saline, and sodium bicarbonate. He emphasizes the importance of monitoring intracranial pressure and the potential for surgical interventions in austere environments. The conversation also touches on the controversial topic of seizure prophylaxis and end-of-life considerations in TBI care.

Takeaways

Dr. Van Wyk is a neurologist with extensive experience in TBI management.

The CRASH-3 trial provides insights into TXA's effectiveness in TBI patients.

Moderate TBI patients may benefit more from TXA than severe cases.

Dosing protocols for TXA are still under discussion, with traditional methods being preferred.

Hypertonic saline is recommended for TBI management, but higher concentrations may be beneficial.

Sodium bicarbonate can be an effective alternative for managing ICP.

Prophylactic use of hypertonic saline is debated but may be reasonable in certain cases.

Seizure prophylaxis is not universally recommended but can prevent complications in TBI patients.

Monitoring ICP through optic nerve sheath diameter is evolving, with trends being more useful than absolute values.

Surgical interventions for TBI may be necessary in austere environments, but should be approached with caution.

Chapters

00:00 Introduction to Traumatic Brain Injury Management

02:00 Insights from the CRASH-3 Trial

06:43 Dosing Protocols for TXA in TBI

11:28 Hypertonic Saline: Concentration and Administration

17:21 Alternative Treatments for Increased ICP

22:58 Prophylactic Sodium Management in TBI

25:17 Seizure Prophylaxis in Traumatic Brain Injury

30:04 Monitoring Intracranial Pressure Non-Invasively

35:17 Surgical Interventions for Elevated ICP

42:10 End-of-Life Decisions in Severe TBI

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