Hypertonic Saline in TBI

[Kiwiology]

Both good points

Now, who has seen my mommy? It's late and the mall closes soon, I don't want to end up with the creepy security guard in his office overnight or nothing ....

[flightmedic608]

^{Hi in response to your topic, we utilize 3% (hypertonic) given at 3 cc/kg with sign/symptoms of increased ICP/herniation. This seems to be the growing trend in neuro care within our region.}

[BushyFromOz]

^{Hi in response to your topic, we utilize 3% (hypertonic) given at 3 cc/kg with sign/symptoms of increased ICP/herniation. This seems to be the growing trend in neuro care within our region.}

When you say signs/symptoms do you literally mean that or do you have transducers to measure ICP?

[krumel]

My old service used HyperHAES, which is hydroethylstarch with 7.5% NaCl for small volume resucitation and - in some very rare cases- for hypotensive head traumas.

Had some good effects on the BP-side, I personally did see much effect on the neurological side.

[flightmedic608]

Hello, while it would be ideal to transport a patient with a ventric in place, most of our administration comes from either scene or ED transports.. We base our administration of Hypertonic Saline base on clinical signs of increased ICP/herniation ie Blood pressure, unilateral pupil change etc

[BushyFromOz]

Hello, while it would be ideal to transport a patient with a ventric in place, most of our administration comes from either scene or ED transports.. We base our administration of Hypertonic Saline base on clinical signs of increased ICP/herniation ie Blood pressure, unilateral pupil change etc

Cool, im unfamiliar with the use of hypertonic solution for raised ICP pre-hospitally, do you routinely see much imrovement with 3ml/kg?

[flightmedic608]

We are more likely to see a change in blood pressure, since we aggressively treat blood pressure(s) to ensure adequate MAPs through the use of vasoactive medications. The reduction of mortality (reduction of secondary brain injury) after giving an agent such as Mannitol or hypertonic saline would be most likely seen in a 24-48 hour time period. Our service follows up with receiving hospitals at the 24 hour and weekly mark until discharged or expired. So we have an opportunity to trend which of our patients have improved neuro outcome.

Here is an interesting article that you may enjoy reading discussing Hypertonic Saline in TBI:

http://www.anesthesia-analgesia.org/content/102/6/1836.full.pdf

[firemedic37]

We don't carry either one on our trucks but they are readily available in our ER. Depending on the doctor working and the patient we will use one or the other when there are signs of herniation.

I have personally taken a few patients with the hypertonic solutions, really no neurological change in the time I had them. I have given Mannitol once in the ER and then they flew the patient out so I again didn't see any neurological changes.

I know that the University of Iowa Hospitals and Clinics prefer Mannitol over hypertonic fluids, they have said that they have seen improvements in patients when they were given Mannitol on scene of traumatic accidents with signs of herniation. I have not seen any studies published by them yet. The only ones I know that actually carry it pre-hospital is their own helicopter, haven't seen or heard about any others actually carrying it yet.