TBI & ICP Management

• Treat ICP above 22 mm Hg; escalate care stepwise: head-up 30° and normocapnia (35–38) plus sedation → hypertonic saline/mannitol → EVD → paralysis → pentobarbital/decompressive craniectomy.
• CPP 60–70 mm Hg; avoid hypoxia and hypotension. Aim for SBP ≥100 at age 50–69 and ≥110 at age 15–49 or >70, adjusting near the age boundaries and to cerebral perfusion.
• Moderate–severe TBI without seizures: prophylaxis is optional; if given, keep it ≤7 days, with levetiracetam a suggested choice (NCS 2024). Never give corticosteroids to treat severe TBI.
• Pupil asymmetry or herniation calls for hyperosmolar therapy plus brief hyperventilation only as a bridge to definitive action.

First tests: Serial GCS and pupils, Noncontrast CT head, Full blood count, PT/INR, aPTT and fibrinogen, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: CT cervical spine, Invasive ICP monitoring, Arterial blood gas.

Repeat monitoring: Serial GCS and pupils, Sodium, potassium, bicarbonate, urea and creatinine.

• Managing Elevated Intracranial Pressure