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Fig. 1 | World Journal of Emergency Surgery

Fig. 1

From: Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

Fig. 1

Consensus flowchart. (1)Collaboration/communication (i.e., check for availability of ICU bed/OR, significant clinical deterioration during transfer, etc.) between different medical specialties (anesthesiology/intensive care/neurocritical care, neurosurgery, neuroradiology, trauma surgery, etc.). (2)Patients with signs/elevated risk of herniation and need for emergent neurosurgery with brain CT scan already done in spoke hospital with neurosurgical consultation. (3)In the case of invasive ABP monitoring, the arterial transducer should be zeroed at the level of the tragus. (4)At risk of needing neurosurgery (including ICP monitoring). (5)Serial examination in the spoke hospital and during transfer to the hub center to detect neuro-worsening. We recommend against the discontinuation of sedation to obtain a reliable neurological evaluation in patients with radiological signs of intracranial hypertension (i.e., midline shift, compression of the basal cisterns, sulcal effacement, etc.). In this scenario, only pupil examination, especially during the transfer, would be useful. (6)Also during transfer. Abbreviations TBI, traumatic brain injury; ICP, intracranial pressure; ICU, intensive care unit; OR, operating room; CT, computed tomography; GCS, Glasgow coma scale; ABP, arterial blood pressure; ECG, electrocardiogram; HR, heart rate; SpO2, peripheral oxygen saturation; ETCO2, end-tidal carbon dioxide; MAP, mean arterial pressure; SAP, systolic arterial pressure; PLT, platelet; PT, prothrombin time; aPTT, activated partial thromboplastin time; POC, point-of-care; TEG, thromboelastography; ROTEM, rotational thromboelastometry; EEG, electroencephalogram; Hb, hemoglobin; PaCO2, arterial partial pressure of carbon dioxide; Na, sodium; CC, critical care

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