Episode 28: Head Injury & TBI

With Dr. (LtCol) Stephen Rush, USAF

This is a packed episode from one of the leaders in our field! Doc Rush joins us again to talk about traumatic brain injury, head injury, and why those two are not the same. 

Listen closely as Doc Rush boils down this complex topic to its essentials. First, he hits on the three main causes of altered mental status in trauma:

  • Hypoxemia from chest injury
  • Hypoperfusion from hemorrhage
  • A blow or jolt to head

Next, he discusses the mortality associated with status epileptics, usually defined as a seizure that lasts longer than five minutes or having more than one seizure within a five-minute period, without returning to a normal level of consciousness between episodes.

Doc discusses an article he co-authored about TBI and hypertonic saline in the last JSOM:

  • DeSoucy, E. S., Cacic, K., Staak, B. P., Petersen, C. D., van Wyck, D., Rajajee, V., … & Rush, S. C. (2021). 23.4% Hypertonic Saline: A Tactical Option for the Management of Severe Traumatic Brain Injury With Impending or Ongoing Herniation. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals21(2), 25-28.

And some final points: Note the subtle but important difference he recommends for target ETCO2 in TBI patients, and why—there is a difference in the values between blood gas and end-tidal.

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