Signs and Symptoms of Elevated Intracranial Pressure

- GCS<8 and suspected TBI
- Rapid decline in mental status
- Fixed dilated pupils(s)
- Cushing’s triad hemodynamics (hypertension, bradycardia, altered respirations)
- Motor posturing (unilateral or bilateral)
- Penetrating brain injury and GCS <15
- Open skull fracture

Hypertonic Saline (HTS) Protocol (goal Na 140-165 meq/L)

- 3% HTS: 250-500 cc bolus, then 50 ml/hr infusion, rebolus as needed for clinical signs
- 5% HTS: decrease above doses by 50%
- 4%: dilute to 3% and use as above. If unable to dilute, can be given as 30 ml bolus and re-dose as needed.
- Central venous line (CVL) preferred for 3% (can be given initially via peripheral IV/IO)
- CVL REQUIRED for 7.5% or higher concentration

Military Acute Concussion Evaluation 2 (MACE 2) Form, 2021

Open the attachment on the side menu or open the below link to print or fill out electronically.

https://www.health.mil/Reference-Center/Publications/2020/07/30/Military-Acute-Concussion-Evaluation-MACE-2

MHS Progressive Return to Activity Following Acute Concussion/Mild TBI

Open the attachment on the side menu or open the below link to print or fill out electronically.

https://jts.amedd.army.mil/assets/docs/cpgs/Progressive_Return_to_Activity_Following_Acute_Concussion_mTBI_Clinical_Recommendation_2021.pdf