There is limited data on TBI in animals. Anticipate TBI in MWDs after trauma in 25-40% of cases.2-6 TBI carries an extremely high mortality; assume a prehospital mortality of >40% in severe TBI cases. Management of MWDs is largely based on recommendations for treating people. Care by HCPs should be directed at efforts to mitigate secondary injury from hypotension, hyperthermia, hyper- and hypoglycemia, hypoxia, hyper-and hypocapnia, acid-base imbalances, electrolyte imbalances, SIRS, MODS, and ARDS. Thus, HCP care should be directed at maintenance of blood pressure, normoxemia, normal ventilation, and normal body temperature.
Brain injury should be suspected in any trauma patient with altered mentation (coma, stupor, depression, lethargy, inappropriate behavior or responses) or with physical evidence of head trauma (e.g., lacerations, abrasions, bruising, swelling, pain, bleeding from the nose or ears).
Figure 47. Characteristic Neurologic Postures on Presentation
A modified veterinary Glasgow Coma Scale (GSC) (Table 22) is validated for use in dogs.7 Data is limited, however, correlating long-term outcome (i.e. prognostication) with initial or serial assessment of GCS in dogs.
Table 22. Modified Veterinary Glasgow Coma Scale
Table 23. Suggested Prognoses Based on Modified Veterinary Glasgow Coma Scale
It is critical to ensure adequate resuscitation and management of cardiovascular and respiratory problems, as hypotension, poor tissue perfusion, and hypoxia lead to progressive brain injury due to the adverse effects of secondary neurological injury due to ischemia, cerebral edema, reperfusion injury, and so forth. (See Figure 48.)
Figure 48. Management Algorithm for TBI for MWDs