Severe injury with presumed TBI

Neurologic examination

Craniotomy with hematoma drainage

Consider placement of ICP monitor

Urgent cranial CT

Operative

Nonoperative

Consider:

HOB elevation
Sedation/pain control
Drainage of CSF
Mild hyperventilation
Mannitol
Hypertonic saline

Continue ICU care:

Ongoing neurologic monitoring
Continued organ system support
Early nutrition
Infection prevention
PUD and DVT prophylaxis as appropriate

Measure ICP and calculate CPP

ICP elevated or CPP depressed

ICP/CPP adequate or not measured

Consider decompressive craniectomy

End

Refractory intracranial hypertension?

Yes

No