Neurocritical Care

, Volume 23, Supplement 2, pp 143–154 | Cite as

Emergency Neurological Life Support: Traumatic Brain Injury

  • Rachel GarvinEmail author
  • Chitra Venkatasubramanian
  • Angela Lumba-Brown
  • Chad M. Miller
Review Article


Traumatic Brain Injury (TBI) was chosen as an Emergency Neurological Life Support topic due to its frequency, the impact of early intervention on outcomes for patients with TBI, and the need for an organized approach to the care of such patients within the emergency setting. This protocol was designed to enumerate the practice steps that should be considered within the first critical hour of neurological injury.


Traumatic brain injury Trauma Neurocritical care Emergency 


  1. 1.
    Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2010.Google Scholar
  2. 2.
    Stiell IG, Nesbitt LP, Pickett W, et al. The OPALS major trauma study: impact of advanced life-support on survival and morbidity. CMAJ. 2008;178:1141–52.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Gausche M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA. 2000;283:783–90.CrossRefPubMedGoogle Scholar
  4. 4.
    Davis DP, Peay J, Sise MJ, et al. The impact of prehospital endotracheal intubation on outcome in moderate to severe traumatic brain injury. J Trauma. 2005;58:933–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Jensen JL, Cheung KW, Tallon JM, Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: a systematic review. CJEM. 2010;12:135–40.PubMedGoogle Scholar
  6. 6.
    Bickell WH, Wall MJ Jr, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Brain Trauma F, American Association of Neurological S, Congress of Neurological S, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24 Suppl 1:S37-44.Google Scholar
  8. 8.
    Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291:1350–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Katsnelson M, Mackenzie L, Frangos S, et al. Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury? Neurosurgery. 2012;70:1095–105.CrossRefPubMedGoogle Scholar
  10. 10.
    Heuer G, Hurst R, le Roux PD. Traumatic Carotid Artery Injury. In: Winn HR, ed. Youmans Textbook of Neurological Surgery. 6th ed. New York: Elsevier; 2011.Google Scholar
  11. 11.
    Samant UB 4th, Mack CD, Koepsell T, Rivara FP, Vavilala MS. Time of hypotension and discharge outcome in children with severe traumatic brain injury. J Neurotrauma. 2008;25(5):495–502.CrossRefPubMedGoogle Scholar
  12. 12.
    Vavilala MS, Bowen A, Lam AM, et al. Blood pressure and outcome after severe pediatric traumatic brain injury. J Trauma. 2003;55(6):1039–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Oddo M, Le Roux PD. What is the etiology, pathogenesis and pathophysiology of elevated intracranial pressure? In: Neligan P, Deutschman CS, editors. The Evidenced Based Practice of Critical Care. Philadelphia: Elsevier Science; 2009.Google Scholar
  14. 14.
    Miller C, Armonda R. Participants in the international multi-disciplinary consensus conference on multimodality monitoring. Monitoring of cerebral blood flow and ischemia in the critically ill. Neurocrit Care. 2014;21(Supple2):S121–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Marmarou A. A review of progress in understanding the pathophysiology and treatment of brain edema. Neurosurg Focus. 2007;22:E1.Google Scholar
  16. 16.
    Stein SC, Smith DH. Coagulopathy in traumatic brain injury. Neurocrit Care. 2004;1:479–88.CrossRefPubMedGoogle Scholar
  17. 17.
    Talving P, Benfield R, Hadjizacharia P, Inaba K, Chan LS, Demetriades D. Coagulopathy in severe traumatic brain injury: a prospective study. J Trauma. 2009;66:55–61.CrossRefPubMedGoogle Scholar
  18. 18.
    Cap AP, Spinella PC. Severity of head injury is associated with increased risk of coagulopathy in combat casualties. J Trauma. 2011;71:S78–81.CrossRefPubMedGoogle Scholar
  19. 19.
    O’Neil BR, Handler MH, Tong S, Chapman KE. Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children. J Neurosurg Pediatr. 2015;8:1–10.Google Scholar
  20. 20.
    Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323:497–502.CrossRefPubMedGoogle Scholar
  21. 21.
    Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury XIII. Antiseizure prophylaxis. J Neurotrauma. 2007;24(Suppl 1):S83–6.PubMedGoogle Scholar
  22. 22.
    Narayan RK, Kishore PR, Becker DP, et al. Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg. 1982;56:650–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Kochanek PM, Carney N, Adelson PD, Suppl1, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents—second edition. Pediatr Crit Care Med. 2012;Suppl1:S1–82.Google Scholar
  24. 24.
    Andrews PJ, Citerio G, Longhi L, et al. NICEM consensus on neurological monitoring in acute neurological disease. Intensive Care Med. 2008;34:1362–70.CrossRefPubMedGoogle Scholar
  25. 25.
    Maas AI, Dearden M, Teasdale GM, et al. Acta Neurochir (Wien). 1997;139:286–94.CrossRefGoogle Scholar
  26. 26.
    Chesnut R, Videtta W, Vespa P, LeRouX P. International multimodality monitoring conference. intracranial pressure monitoring: fundamental considerations and rationale for monitoring. Neurocrit Care. 2014;21:564–84.CrossRefGoogle Scholar
  27. 27.
    Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg. 2008;106:240–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Ehtisham A, Taylor S, Bayless L, Klein MW, Janzen JM. Placement of external ventricular drains and intracranial pressure monitors by neurointensivists. Neurocrit Care. 2009;10:241–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Bauer DF, McGwin G Jr, Melton SM, George RL, Markert JM. The relationship between INR and development of hemorrhage with placement of ventriculostomy. J Trauma. 2011;70:1112–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Timofeev I, Dahyot-Fizelier C, Keong N, et al. Ventriculostomy for control of raised ICP in acute traumatic brain injury. Acta Neurochir Suppl. 2008;102:99–104.CrossRefPubMedGoogle Scholar
  31. 31.
    Birch AA, Eynon CA, Schley D. Erroneous intracranial pressure measurements from simultaneous pressure monitoring and ventricular drainage catheters. Neurocrit Care. 2006;5:51–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Martinez-Manas RM, Santamarta D, de Campos JM, Ferrer E. Camino intracranial pressure monitor: prospective study of accuracy and complications. J Neurol Neurosurg Psychiatry. 2000;69:82–6.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of depressed cranial fractures. Neurosurgery. 2006;58:S56–60.PubMedGoogle Scholar
  34. 34.
    Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of posterior fossa mass lesions. Neurosurgery. 2006;58:S47–55.PubMedGoogle Scholar
  35. 35.
    Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58:S25–46.PubMedGoogle Scholar
  36. 36.
    Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58:S16–24.PubMedGoogle Scholar
  37. 37.
    Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58:S7–15.PubMedGoogle Scholar
  38. 38.
    Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502.CrossRefPubMedGoogle Scholar
  39. 39.
    Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev. 2006:CD003983.Google Scholar
  40. 40.
    Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80:2250–7.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    West TA, Marion DW. Concurrent recommendations for the diagnosis and treatment of concussion in sport: a comparison of three new guidelines. J of Neurotrauma. 2014;31:159–68.CrossRefGoogle Scholar
  42. 42.
    Centers for Disease Control and Prevention (2013). Injury prevention and control. Available at: Accessed September 30, 2013.
  43. 43.
    Guerriero RM, Proctor MR, Mannix R, Meehan WP III. Epidemiology, trends, assessment and management of sports-related concussion in United States high schools. Curr Opin Pediatr. 2012;24:696–701.CrossRefPubMedGoogle Scholar
  44. 44.
    Harmon K, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Clin J Sport Med. 2013;23:1–18.CrossRefPubMedGoogle Scholar
  45. 45.
    Marsh AM, Fraser D, Marsh JP. Management of concussion in the pediatric patient. J Pediatr Health Care. 2013;27:499–504.CrossRefPubMedGoogle Scholar
  46. 46.
    Langlois JA, Rutland-Brown W, and Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention, National Center for Injury and Prevention Control, Atlanta 2006 (Statistical data).Google Scholar
  47. 47.
    Faul M, Xu L, Wald MM, and Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010 (Statistical data).Google Scholar
  48. 48.
    Morray JP, Tyler DC, Jones TK, et al. Coma scale for use in brain injured children. Crit Care Med. 1984;12:1018–20.CrossRefPubMedGoogle Scholar
  49. 49.
    Kapapa T, Konig K, Pfister U, et al. Head trauma in children, part 1: admission, diagnosis, and findings. J Child Neurol. 2010;25:146–56.CrossRefPubMedGoogle Scholar
  50. 50.
    Simpson D, Reilly P. Pediatric coma scale. Lancet. 1982;2:450.CrossRefPubMedGoogle Scholar
  51. 51.
    James HE. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann. 1986;15:16–22.CrossRefPubMedGoogle Scholar
  52. 52.
    Badjatia N, Carney N, Crocco TJ, et al. Guidelines for prehospital management of tramatic brain injury, 2nd edition. Prehosp Emerg Care. 2008;12(Suppl 1):S1–52.CrossRefPubMedGoogle Scholar
  53. 53.
    Pang D. Spinal cord injury without radiologic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325–42.CrossRefPubMedGoogle Scholar
  54. 54.
    Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81.CrossRefPubMedGoogle Scholar
  55. 55.
    Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow coma scale in children with blunt head trauma. Acad Emerg Med. 2005;12:814.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Rachel Garvin
    • 1
    Email author
  • Chitra Venkatasubramanian
    • 2
  • Angela Lumba-Brown
    • 3
  • Chad M. Miller
    • 4
  1. 1.University of Texas Science Health Science CenterSan AntonioUSA
  2. 2.Stanford UniversityStanfordUSA
  3. 3.Pediatric Emergency MedicineWashington University School of MedicineSt. LouisUSA
  4. 4.OhioHealthColumbusUSA

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