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Traumatic brain injury

Intended Learning Outcomes


TBI Part I: Introduction and early management
Summarise the main aims in early stage of TBI management Describe the steps of immediate assessment of TBI Describe the choice of fluid resuscitation and hyperosmolar therapy in patients with TBI Explain the importance of Tranexamic acid use in TBI Describe the pathophysiology and importance of neurogenic pulmonary edema and cardiac regional wall abnormalities in patients with TBI Discuss basic neurologic monitoring in patients with TBI List and describe investigations required in patients with TBI Describe a detailed neurological examination in patients with TBI Discuss issues around criteria for referral to a tertiary neurosurgical centre in patients with TBI


TBI Part II:Secondary Brain Injury
Define secondary brain injury Describe the difference between primary to secondary brain injury Recognise the extra-cranial and intra-cranial causes of secondary brain insults Describe image findings of intra-cerebral lesions and consequences in TBI patients including: Mass effect, Focal lesions, Skull fractures, tSAH, Epidural hematoma, Subdural hematoma, and Traumatic contusion/laceration and intracerebral hematoma


TBI Part III: Assessment and Management of Severe TBI
Identify the most important aspect in the assessment of severe patients with TBI Explain the role of ICP monitoring in patients with TBI Describe further monitoring techniques for TBI patients Describe therapeutic interventions in TBI patients and list the criteria for specific interventions such as surgery Discuss basic and second line interventions in brain oedema in patients with TBI


TBI Part IV: General Intensive Care for Patients with TBI
Discuss the importance of optimising general intensive care for patients with TBI Summarise the respiratory system management in patients with TBI Describe the gastrointestinal system, nutrition and stress ulceration aspects in patients with TBI Discuss the metabolic disturbances and management in patients with TBI Describe DVT prophylaxsis in patients with TBI Discuss the prevention and control of infections in patients with TBI Describe overall management of extracranial injuries in patients with TBI


TBI Part V: Complications and Outcomes
Summarise and describe late complications of severe TBI Describe the diagnosis and treatment post-traumatic hydrocephalus Describe the management of the sunken skin flap syndrome Discuss the appropriate management of post-traumatic meningitis Outline the principles of identification and management of carotid-cavernous fistulae Desribe outcome prediction in patients with severe TBI Explain the importance of audit and benchmarking in ICUs managing patients with TBI

eModule Information

Relevant Competencies from CoBaTrICE


TBI Part I: Introduction and early management
1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology 1.4 Triages and prioritises patients appropriately, including timely admission to ICU 1.5 Assesses and provides initial management of the trauma patient 3.6 Recognises and manages the patient with neurological impairment 4.3 Administers blood and blood products safely


TBI Part II:Secondary Brain Injury
2.2 Undertakes timely and appropriate investigations 2.8 Liaises with radiologists to organise and interpret clinical imaging 2.9 Monitors and responds to trends in physiological variables 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis 3.6 Recognises and manages the patient with neurological impairment 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation 6.3 Manages the care of the patient following craniotomy under supervision


TBI Part III: Assessment and Management of Severe TBI
2.2 Undertakes timely and appropriate investigations 2.8 Liaises with radiologists to organise and interpret clinical imaging 2.9 Monitors and responds to trends in physiological variables 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis 3.6 Recognises and manages the patient with neurological impairment 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation 6.3 Manages the care of the patient following craniotomy under supervision


TBI Part IV: General Intensive Care for Patients with TBI
2.9 Monitors and responds to trends in physiological variables 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis 3.6 Recognises and manages the patient with neurological impairment 3.7 Recognises and manages the patient with acute gastrointestinal failure 4.1 Prescribes drugs and therapies safely 4.2 Manages antimicrobial drug therapy 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support 4.7 Initiates, manages and weans patients from renal replacement therapy 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances 4.9 Co-ordinates and provides nutritional assessment and support 6.3 Manages the care of the patient following craniotomy under supervision 6.5 Manages the pre- and post-operative care of the trauma patient under supervision 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families 7.2 Manages the assessment, prevention and treatment of pain and delirium 7.3 Manages sedation and neuromuscular blockade 7.5 Manages the safe and timely discharge of patients from the ICU


TBI Part V: Complications and Outcomes
2.9 Monitors and responds to trends in physiological variables 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis 3.6 Recognises and manages the patient with neurological impairment 6.3 Manages the care of the patient following craniotomy under supervision 6.5 Manages the pre- and post-operative care of the trauma patient under supervision 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload 11.8 Demonstrates an understanding of the managerial & administrative responsibilities of the ICM specialist

Faculty Disclosures:
The authors of this module have not reported any disclosures.

Copyright©2017. European Society of Intensive Care Medicine. All rights reserved.
ISBN 978-92-95051-54-6 - Legal deposit D/2005/10.772/1

References: