A meta-analysis performed by Gu et al compared the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury. Gu et al performed this meta-analysis because of the lack of systematic reviews or meta-analysis available, which focus on TBI patients in the comparison of the safety and efficacy of propofol and midazolam.
The analysis involved four small, randomised controlled trials that compared the impact of the two drugs on ICP and cerebral perfusion pressure (CPP). Two of these studies also included the impact the two drugs had on mortality and GOS.
After eight days in the neurotrauma unit, Mr Smith’s raised intracranial pressure (ICP) remained refractory to medical intervention and
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While Mr Smith had a DC performed as a last-tier intervention, DC may also be performed as an early intervention. Two recent randomised controlled trials have compared the effectiveness of DC to reduce ICP and mortality compared with medical intervention alone. Cooper et al performed the Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA) Trial in 2011. The DECRA Trial had a cohort of 155 patients, aged 15 to 59 years old, with severe, nonpenetrating, traumatic brain injury (TBI), calculated by a GCS of equal or less than eight.
To meet criteria the cohort needed an ICP of 20 mmHg or greater for a minimum of 15 minutes after first-tier medical intervention. Once the cohort was randomised into a medical group and a surgical group, the surgical group had DC performed within 72 hours.
Early results found the DC group required less intervention to achieve a lower ICP than the receiving medical intervention alone. The DC group also had a shorter duration of intubation and earlier Intensive Care Unit (ICU) discharge, however this did not change the overall duration of hospital admission. At the six months follow-up, 70 percent of patients in the DC group presented with unfavourable outcomes, categorised as ranging from one to four on the Extended Glasgow Outcome Scale (GOS-E). This gave an odds ratio of
The Chart below shows that during 2002-2007, there were 854 Major traumatic brain injuries compared to 887 from 1996-2001. This proved that my hypothesis was correct in saying
GDT has been found to be the pillar upon which the Enhanced Recovery after Surgery (ERAS) program is built upon. The downside of this technique is that it does not work well for bedside applications and most specialists do not allow the use of this method on a day-to-day basis. In the past few years, the use of GDT policies has been suggested as an important part of the ERAS package. The main concept of this plan is to have a myriad of solutions that will automatically lead to a better result in magnitude (Trinooson & Gold, 2013). Most of the studies, however have analyzed the effect and impact of implementation of the ERAS program. With regards to this shortcoming, it can be conclusively said that the outcome of using GDT mediation cannot be seen
The purpose of this case study is to examine the specific case study of a 40 year old male who suffered a traumatic brain injury as the result of a fall from a roof. For future reference the term "Traumatic Brain Injury" will be abbreviated here as TBI and "Intracranial Pressure" as ICP. In this study we will explore the medical findings that are common in such an injury and how they relate to the Paramedic in the field. The specificity of this case will be broken down to define relevant terminology and findings that were present to the paramedics that responded to this call. Lastly, TBI's will be explored and discussed for their relevance in the field, contributing factors and comorbidities as they relate to paramedicine.
Traumatic brain injuries (TBIs) in the military are a tangible threat to the men and women of the United States military. Operations in Iraq and Afghanistan have created a spotlight on this injury, as the “signature injury”. Specific criteria makeup the definition of a TBI, which is certain symptoms and severity levels of those symptoms. Due to the capacity of this injury, the Department of Defense (DoD) and Congress have created mandates, along with treatment methods, and the ability to achieve an end goal of aiding an individual’s complete recovery.
Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.
Traumatic brain injury (TBI) has affected many people, but has hardly raised awareness; in fact according to Marcia Clemmitt “About 1.7 million Americans suffer a traumatic brain injury (TBI) every year…Yet, while they affect so many people, TBI has received little medical-research funding until brain injuries from the wars in Iraq and Afghanistan … began to mount in recent years.”(Clemmitt) For such a long time many people were unaware of what traumatic brain injury even meant; Up until a numerous groups of veterans that came back home, from Afghanistan were found to suffer from traumatic brain injuries. Due to the discovery, the people that already suffered from traumatic brain injury
Considering no two brain injuries are the same, treatment is stipulated accordingly. In the case of mild injury management, it is fairly low maintenance, requiring a lot of rest and over-the-counter pain medicine. However, the patient must be monitored religiously in case of worsening or new symptoms where immediately medical attention is vital. Once cleared by a doctor, the patient steadily returns to their normal schedules. Immediately after moderate and severe injuries, treatment is concentrated on prevention of secondary damage resulting from inflammation, bleeding, or reduced oxygen supply to the brain. Medications prescribed to diminish chance of secondary loss include diuretics, anti-seizure drugs, and coma-inducing drugs. Surgery is crucial in removing hematomas (clotted blood), repairing skull fractures, and opening a window in the skull in order to relieve pressure and allow room for swelling. A large part of treatment is rehabilitation. The goal is to get patients back to their normal daily routines. Rehab usually
Medical and technological advances have led to greater survival rates in individuals suffering from various illness and injury throughout history. This includes individuals who suffer traumatic and nontraumatic brain injuries. Approximately 1.5 million people in the United States sustain a brain injury each year with the survival rate of over 90 percent making brain injury the leading cause for disability in the United States. (Mysiw, Bogner, Corrigan, Fugate, Clinchot, & Kadyan 2006). Cognitive, physical, sensory and behavioral changes are widely noted in individuals in the months and years following a brain injury. However, the psychosocial, psychological and emotional effects of these injuries are less discussed and therefore these aspects can be overlooked when anticipating a course of treatment. Individuals who sustain acquired brain injuries experience significant, lasting impairment in the psychosocial, psychological and emotional aspects of their lives and better understanding of these issues can lead to better treatment and coping skills for these individuals.
As described in Table 3, patients in DCD group had longer anhepatic phase (76 vs.54 minutes, p = 0.007) than in DBD group. The length of ICU stay was significantly shorter in the DBD group, compared with in the
Professor Leslie Matthews of Morehouse School of Medicine is a trauma surgeon who treats TBI patients. He and his colleagues have just published a case series of a new successful treatment of TBI.
A traumatic brain injury (“TBI”) occurs when the brain is somehow injured, rattled, or wounded from an external source of force. The means of acquisition and the severity of TBIs are unique to each patient; therefore, symptoms and rehabilitation can vary greatly depending on the patient’s condition following the incident and how they sustained the injury. The severity of a TBI is generally classified into one of three categories: mild, moderate, or severe, and this type of diagnostic criteria influences how a patient with TBI is treated by medical staff and rehabilitation specialists. TBIs can affect a specific part of the brain that was directly impacted, leaving the patients with only one or a few areas of impairment, or the damage can
Traumatic brain injury (TBI) is a type of injury that is a critical public health and socio-economic problem. TBI is a leading cause of death and disability in both children and adults [5]. The Centers for Disease Control and
Extensive research offers hope for the growing numbers of people suffering from traumatic brain injuries that often leave victims unable to return to their previous lifestyle and sometimes require long-term care. Traumatic brain injuries are quite common from car accidents, a blow to the head, sports accidents, and in military veterans. These injuries have a long term effect that changes lives of many individuals. Some brain injuries, even have the power to change the way one speaks and complete simple everyday tasks which restrict one to be independent.
A traumatic brain injury (“TBI”) occurs when the brain is somehow injured, rattled, or wounded from an external source of force. The means of acquisition and the severity of TBIs are unique to each patient; therefore, symptoms and rehabilitation can vary greatly depending on the patient’s condition following the incident and how they sustained the injury. The severity of a TBI is generally classified into one of three categories: mild, moderate, or severe, and this type of diagnostic criteria influences how a patient with TBI is treated by medical staff and rehabilitation specialists. TBIs can affect a specific part of the brain that was directly impacted, leaving the patients with only one or a few areas of impairment, or the damage can
The purpose of this research is to measure the efficacy of Hyperbaric Oxygen Therapy (HBOT) in treating patients with Traumatic brain injury (TBI). Hyperbaric oxygen therapy (HBOT) is one of the newest but promising treatment therapies for patients with TBI. While the standard treatment for TBI involve the removal of the cause, restoring perfusion, supporting metabolic requirement and limiting inflammatory and oxidative damage, (HBOT) on the other hand involve intermittent inhalation of oxygen at 100% and above normal atmospheric pressure. This process is intended enhances neurological recovery in TBI patients. Two groups of participants with 20 patients in each group were used for the study after careful analysis of their medical records.