Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, Q&A 06

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Student tip: This case is a helpful description of drugs used and how to stabilise a patient with brain trauma.

Question	Answer		Article
Match the following therapies for traumatic brain injury (a-g) with the associated comment (i - vii): a) High-dose corticosteroids b) Mannitol c) Withholding fluids d) Hypertonic saline e) Hydroxyethyl starch f) Furosemide g) Supplemental oxygen. i) Osmotic diuretic that is an oxygen-radical scavenger ii) A loop diuretic that may reduce the rebound increase in ICP that can follow mannitol administration iii) May increase arterial oxygen content iv) Will promote decreased blood flow and contribute to lowering cerebral perfusion pressure v) Will promote intravascular volume replacement and MAP vi) A hyperosmolar crystalloid that may reduce ICP and neutrophil adhesion vii) Has no effect on improving outcome in traumatic brain injury, and is associated with increased mortality.	a, vii; b, i; c, iv; d, vi; e, v; f, ii; g, iii.		Link to Article
List at least three strategies for improving outcome in traumatic brain injury.	Maintain SAP >90 mmHg, attempt to reduce intracranial pressure with osmotic diuretics; promote arterial oxygen content with supplemental oxygen (PaO2 >80 mmHg [SpO2 >94%]); avoid interventions and therapy that may contribute to regional brain ischemia (e.g. compressing both jugular veins) or excessive cerebral blood flow; maintain normal head position; elevate head, neck, and shoulders up to 20 degrees; maintain PCO2 between 35 and 45 mmHg; maintain blood glucose within normal range; early enteral nutrition; avoid hyperthermia; promptly control seizures or thrashing; rapidly correct systemic problems that affect BP and oxygenation.		Link to Article

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