Summary of Changes

1. Clarification of the use of the Military Acute Concussion Evaluation 2 (MACE2) for mild traumatic brain injury (mTBI).
2. Clarification of the use of hypertonic saline or normal saline during resuscitation.
3. Addition of the recommendation to use quantitative pupillometry for evaluation of pupillary reactivity.
4. Addition of recommendation for Ketamine as a sedative in severe TBI.
5. Addition of recommendation for tranexamic acid (TXA).
6. Addition of recommendations to consider placement of Brain Tissue Oxygen Monitor (PbtO2) and maintaining > 20mmHg.
7. Addition of recommendation for vascular imaging of penetrating brain injuries to rule out traumatic pseudoaneurysms.
8. Changed seizure prophylaxis for TBI to make Levetiracetam the preferred agent and dilantin a third line agent given the inability to obtain drug levels in austere environments. Added in Vimpat as a second line agent for seizure prophylaxis.
9. Addition of treatment algorithms for treating elevated intracranial pressure, decreased PbtO2, or both.