Neurotrauma and Critical Care
Core concepts
Master the classification and management of traumatic brain injury (TBI), including the Glasgow Coma Scale, the Marshall and Rotterdam CT classifications, and the distinction between focal and diffuse injury. Understand the surgical indications for epidural and subdural hematoma evacuation, contusion, and decompressive craniectomy. Know the principles of severe TBI critical care: avoidance of hypoxia and hypotension, ICP monitoring thresholds, CPP targets, sedation, osmotherapy, and the role of hyperventilation as a temporizing measure only. Also cover spinal trauma: clearance algorithms, ASIA grading, and timing of decompression.
Traps
- Using hyperventilation as a sustained treatment rather than a brief bridge for herniation; prolonged hypocapnia causes ischemia.
- Missing the lucid interval in epidural hematoma, which is a classic question stem.
- Forgetting that hypotension and hypoxia are the strongest modifiable secondary-injury factors.
- Assuming a normal CT excludes clinically significant injury in an anticoagulated patient.
Worked example / rule of thumb
A patient with a blow to the temple, brief loss of consciousness, a lucid interval, then rapid decline, with a biconvex hyperdense collection on CT, has an epidural hematoma, usually from a middle meningeal artery tear, and needs urgent craniotomy. Rule of thumb for severe TBI: first secure ABCs and avoid a single episode of systolic BP below 90 mmHg or oxygen saturation below 90%, because each doubles mortality risk.