Rotor 4 · 18 min · rotor

TBI storm

BTF 4th ed. · 6 mL/kg PBW · Pplat ≤30 · ΔP ≤14 · SpO₂ 92–96 · PaCO2 35–45

Load card puts the starting breath on the box. Connect starts the clock. End whenever you want.

28-year-old motorcycle vs. deer.

Rest of the scene

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.

3 objectives
  1. 1

    Kill the asynchrony

    Deepen (paralysis flag), shorten Ti, raise ETS, or raise support.

  2. 2

    PaCO2 35–45 (BTF)

    Once he is quiet, set a rate. 39 is inside the window. Do not hand it to ASV.

  3. 3

    No hypoxic seconds

    One desat is an ICP spike.

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