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Authors

  1. Causer, Thomas RN, RRT, BSN
  2. Zipf, Jami BSN, RN
  3. George, Nickole Tickerhoof PhD, RN

Abstract

Management of traumatic brain injury is rapidly changing to a focused approach requiring clinical expertise from the bedside nurse. Preventing secondary injury in the penumbra is the ultimate goal by maximizing cerebral perfusion. The "Guidelines for Management of Severe Traumatic Brain Injury" developed by the Brain Trauma foundation indicates the need for a process to include assessing the relationship between CPP and cerebral ischemia. The goal in achieving best practices and improved outcomes does not come easily. Clayton reported that evidence-based protocols in the management of patients with traumatic brain injury in the intensive care unit have shown a significant reduction in mortality. The first step must include a coordinated approach from a multi disciplinary team of trauma surgeons, neurosurgeons, and critical care nurses to develop and implement new guidelines. Conemaugh Memorial Medical Center's trauma, critical care, and neurosurgical departments took on this daunting task. Current practices were reviewed and a comprehensive literature research was completed with areas for needed improvement identified. Extensive guidelines were developed to include each phase of care following the "Guidelines for Management of Severe Traumatic Brain injury." Step-by-step algorithms outline what treatment modality should come next when a patient is not responding to current therapy. A thorough educational program was then designed to include all disciplines involved in the care of the patient. In the months following implementation, review of cases was completed and guidelines were revised. This process continues to evolve as we learn more about the relationship between ICP, CPP, and brain oxygenation. Collaboration between the disciplines of neurosurgery, trauma, and critical care is essential in guideline development and implementation with the ultimate goal of improved outcomes in the traumatic brain injured patient. The critical care nurse was crucial in the development and implementation of these guidelines. They embraced the concepts and took ownership for the process.