An Evidence-Based Approach To Severe Traumatic Brain Injury In Children

Friess, Stuart H. MD
Helfaer, Mark A. MD, FCCM
Raghupathi, Ramesh PhD
Huh, Jimmy W. MD
Herman, Martin I. MD, FAAP, FACEP
Hostetler, Mark A. MD, MPH

²Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
³Professor, Division Director of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
⁴Associate Professor, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA
⁵Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
⁷Professor of Pediatrics, UT College of Medicine, Assistant Director of Emergency Services, Lebonheur Children's Medical Center, Memphis, TN
⁸Assistant Professor, Department of Pediatrics; Chief, Section of Emergency Medicine; Medical Director, Pediatric Emergency Department, The University of Chicago, Pritzker School of Medicine, Chicago, IL

Date of original release: December 1, 2007

Date of most recent review: November 1, 2007

Termination date: December 1, 2010

Time to complete activity: 4 hours

Medium: Print & online

Method of participation: Print or online answer form and evaluation

See “Physician CME Information” on back page.

Pediatric Emergency Medicine Practice 4(12):p 1-22, December 2007.

A four-year-old boy is an unrestrained passenger in a motor vehicle crash and has been brought via EMS to your ED. He was not responsive at the scene, with equal and reactive pupils. Endotracheal intubation was unsuccessful at the scene and he has been receiving bag mask ventilation en route. You look at the monitor and see that his pulse is 80 and his blood pressure is 140/90 with an oxygen saturation of 100%. The resident yells out that his left pupil is 7 mm and minimally reactive and his right pupil is 3 mm and reactive. He extends to painful stimuli on the left and does not move his right side. Several questions run through your mind. How am I going to secure this patient's airway? Do I hyperventilate this patient; if so, how much? What about mannitol? Or should I use hypertonic saline? What is the likelihood of a good outcome?