Summary of Changes
- Clarification of the use of the Military Acute Concussion Evaluation 2 (MACE2) for mild traumatic brain injury (mTBI).
- Clarification of the use of hypertonic saline or normal saline during resuscitation.
- Addition of the recommendation to use quantitative pupillometry for evaluation of pupillary reactivity.
- Addition of recommendation for Ketamine as a sedative in severe TBI.
- Addition of recommendation for tranexamic acid (TXA).
- Addition of recommendations to consider placement of Brain Tissue Oxygen Monitor (PbtO2) and maintaining > 20mmHg.
- Addition of recommendation for vascular imaging of penetrating brain injuries to rule out traumatic pseudoaneurysms.
- 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.
- Addition of treatment algorithms for treating elevated intracranial pressure, decreased PbtO2, or both.