Rotor 4 · 18 min · rotor

TBI storm

BTF 4th ed. · 92–96% (trainer band — avoid hyperoxia) · 6 mL/kg PBW (4–8) · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 35–45 (BTF)

28-year-old motorcycle vs. deer. GCS 4, blown right pupil, fighting the tube despite fentanyl. Short rotor to the neuro ICU.

Handoff

You will not win with a perfect VT if he coughs every four seconds. Synchrony is ICP control. Then CO2.

1
Kill the asynchrony
Deepen (paralysis flag), shorten Ti, raise ETS, or raise support.
2
PaCO2 35–45 (BTF)
Once he is quiet, set a rate. 39 is inside the window. Do not hand it to ASV.
3
No hypoxic seconds
One desat is an ICP spike.

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