Stein – Contemporary Management of the Patient with Severe Traumatic Brain Injury

Dr. Deborah Stein delivers a lecture on the contemporary management of patients with severe traumatic brain injury (TBI), emphasizing a practical approach to care in trauma centers. She begins by highlighting the epidemiology of TBI, noting its high incidence and economic cost, while also pointing out the increased risk of psychiatric disorders and criminality among survivors. Dr. Stein discusses the importance of preventing secondary insults like hypoxia and hypotension, tailoring blood pressure management to the patient's age. She explains the Monroe-Kelly Doctrine to illustrate how elevated intracranial pressure leads to death and identifies patients at high risk of imminent death from brain injury. The lecture covers various management strategies, including ICP monitoring, hyperosmolar therapy, CSF drainage, temperature management, and decompressive craniectomy, while also addressing the systemic effects of TBI and the importance of a balanced approach to patient care, advocating for normoxia, normotension, normocarbia, and normothermia. She also touches on the potential benefits of plasma and TXA in TBI management, while noting the conflicting evidence.