# Traumatic Brain Injury — GCMD Library living collection

Everything in the library about traumatic brain injury — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 88 cited statements

## Episodes
### Acute Management
- [Traumatic Brain Injury](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942) — podcast · 14:04 · [machine version](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942.md)

### Case-Based Learning
- [Solid Organ Injury Management: Update Course 2017](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406) — video · 32:57 · [machine version](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406.md)

### In-Depth Reviews
- [Pediatric Trauma With Dr. Richard Falcone](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928) — podcast · 56:05 · [machine version](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=0) Case Presentation: Multi-System Trauma Initial Assessment (Ep 1)
- [7:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=420) Resuscitation Strategy and Imaging Decisions (Ep 1)
- [15:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=900) ATOMAC Guidelines and Operative Decision-Making (Ep 1)
- [25:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1500) Case Resolution and Key Teaching Points (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=0) Introduction and Center Overview (Ep 2)
- [4:32](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=272) C-Spine Clearance Protocols (Ep 2)
- [15:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=910) C-Spine Clearance in Young Children (Ep 2)
- [18:48](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1128) Infant C-Spine Clearance (Ep 2)
- [20:48](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1248) Pancreatic Trauma Management (Ep 2)
- [27:44](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1664) Non-Accidental Trauma Screening (Ep 2)
- [33:09](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1989) Ophthalmologic Exams in Abuse Screening (Ep 2)
- [34:29](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2069) Blunt Abdominal Trauma Screening (Ep 2)
- [41:26](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2486) Angiography in Pediatric Solid Organ Injury (Ep 2)
- [43:49](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2629) Solid Organ Injury Management Updates (Ep 2)
- [48:28](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2908) Trauma Activation Criteria (Ep 2)
- [54:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3290) Closing and Conference Announcement (Ep 2)
- [0:11](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=11) Case presentation and initial management of pediatric TBI with epidural hematoma (Ep 3)
- [1:53](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=113) Management of intracranial hypertension and cerebral perfusion pressure (Ep 3)
- [6:30](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=390) Role of steroids in pediatric TBI (Ep 3)
- [6:52](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=412) Surgical options for refractory intracranial hypertension (Ep 3)
- [8:56](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=536) Imaging strategy: CT versus MRI in acute and subacute phases (Ep 3)
- [10:39](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=639) Recognition and management of sympathetic storming (Ep 3)
- [13:16](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=796) Clinical pearls summary (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "A normal shock index is less than 1 or less than 0.9, with adjustments now available for pediatric patients" — David (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=420)
- "The shock index allows clinicians not regularly seeing pediatric patients to assess for shock without knowing normalized blood pressure values for children" — David (clinical) [Ep 1 · 7:30](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=450)
- "Massive transfusion protocol must be activated as soon as massive bleeding is recognized, not after reaching a specific threshold, to make a difference in outcome" — David (clinical) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=540)
- "FAST (Focused Assessment with Sonography for Trauma) examines four specific areas: three in the abdomen and one in the pericardial sac, looking only for hemoperitoneum or pericardial effusion, not organ injury" — David (clinical) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=780)
- "FAST has lost appeal in stable pediatric trauma patients because it misses too many injuries, as shown by the PECARN Group study" — David (host_summary) [Ep 1 · 14:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=840)
- "FAST remains useful in unstable patients as a replacement for diagnostic peritoneal lavage (DPL)" — David (opinion) [Ep 1 · 14:30](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=870)
- "The ATOMAC guideline divides patients into stable and unstable categories: stable patients can be transfused to hemoglobin >7 and discharged when bleeding stops; unstable patients who don't respond to packed cells and fluids need operative intervention" — David (guideline) [Ep 1 · 20:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1200)
- "Young children with head injury are often hypotensive even without active bleeding, while some bleeding children are not hypotensive, making it difficult to define 'stable' vs. 'unstable'" — David (clinical) [Ep 1 · 21:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1260)
- "Hypotension due to solid organ injury is ominous, with significant risk of death and failure of non-operative management" — David (clinical) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1320)
- "In younger children (not teenagers), blood pressure less than 50 mmHg is a really ominous sign with high risk of poor outcome" — David (clinical) [Ep 1 · 22:30](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1350)
- "Teenagers and adults can become hypotensive, respond to blood transfusion, and often be managed non-operatively, unlike younger children" — David (clinical) [Ep 1 · 23:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1380)
- "Adult studies show that ideal blood pressure after head injury is much higher than previously thought, with blood pressure of 150-160 mmHg associated with better outcomes than 90-120 mmHg, suggesting Cushing's reflex may be protective" — David (host_summary) [Ep 1 · 24:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1440)
- "In patients with traumatic brain injury and shock, resuscitation should be managed based on cerebral perfusion pressure rather than absolute blood pressure when intracranial monitoring is in place" — David (clinical) [Ep 1 · 25:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1500)
- "The ATOMAC guideline was modified 8 months into the prospective study to specify that recurrent hypotension or lack of sustained response to packed cells constitutes failure of non-operative management, after a patient with multiple injuries died following recurrent hypotension in the PICU" — David (guideline) [Ep 1 · 27:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1620)
- "The ATOMAC guideline effectively guided care for 1,007 pediatric trauma patients in the prospective validation study" — David (epidemiological) [Ep 1 · 28:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1680)
- "Only about half of children in shock are hypotensive, meaning shock does not necessarily equal low blood pressure in pediatric patients" — David (clinical) [Ep 1 · 28:30](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1710)
- "40 mL/kg (or 4 units of packed cells) remains a validated threshold for failure of non-operative management, supported by both expert opinion and military experience data" — David (guideline) [Ep 1 · 32:00](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1920)
- "Blood evacuated from the chest via chest tube may originate from abdominal bleeding through a ruptured diaphragm, making it difficult to determine whether chest tube output should count toward the 40 mL/kg solid organ injury transfusion threshold" — David (clinical) [Ep 1 · 32:30](https://library.globalcastmd.com/watch/solid-organ-injury-management-update-course-2017-406?t=1950)
- "Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 patients per year." — Richard Falcone (clinical) [Ep 2 · 3:08](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=188)
- "At Cincinnati Children's, the ED physician serves as team leader for all traumas, chosen because they are present when the patient arrives." — Richard Falcone (clinical) [Ep 2 · 3:32](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=212)
- "The ultimate risk of C-spine injury in pediatric trauma is actually pretty low." — Richard Falcone (epidemiological) [Ep 2 · 4:32](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=272)
- "Approximately 90% of children admitted in C-collars can be clinically cleared the next morning when they are less distracted and not in the trauma bay." — Richard Falcone (clinical) [Ep 2 · 4:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=290)
- "The Trauma Association of Canada Pediatric Subcommittee published evidence-based C-spine clearance recommendations in the Journal of Trauma 2-3 years ago, emphasizing clinical exam as the first test." — Richard Falcone (host_summary) [Ep 2 · 6:04](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=364)
- "For children greater than 8 years with normal X-rays and normal neurologic exam, re-examination is recommended; if the repeat exam is normal, the C-spine can be cleared without further imaging." — Richard Falcone (host_summary) [Ep 2 · 7:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=420)
- "CT or MRI of the C-spine should only be considered for patients with abnormal neurologic exam findings." — Richard Falcone (host_summary) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=450)
- "Getting CT early in kids with normal neurologic exam and persistent tenderness is not useful because you won't feel comfortable removing the collar based on imaging alone without clinical improvement." — Richard Falcone (clinical) [Ep 2 · 8:27](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=507)
- "There is enough evidence now that you don't need to get an X-ray on every awake child without distracting injuries and no midline tenderness." — Richard Falcone (clinical) [Ep 2 · 9:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=590)
- "A multi-site study published in Journal of Trauma around 2009 developed a point system for C-spine injury risk in children under 3: 3 points for GCS <14, 2 points for GCSI score of 1, 2 points for motor vehicle collision, 1 point for age 2-3 years." — Richard Falcone (host_summary) [Ep 2 · 16:07](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=967)
- "Children under 3 with a C-spine risk score of 0 or 1 had a 0.0% chance of C-spine injury and don't need imaging." — Richard Falcone (host_summary) [Ep 2 · 17:30](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1050)
- "Children under 3 with a C-spine risk score of 7 or 8 had about a 21% chance of having a C-spine injury and need imaging." — Richard Falcone (host_summary) [Ep 2 · 18:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1080)
- "Pediatric Level 1 centers were getting C-spine CTs only 17% of the time compared to adult centers which were getting them 24-45% of the time, indicating adult centers are doing too many CTs overall for pediatric patients." — Richard Falcone (host_summary) [Ep 2 · 18:30](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1110)
- "The challenge in pancreatic trauma is determining whether there is a duct injury or not, which is the number one question and concern." — Richard Falcone (clinical) [Ep 2 · 21:35](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1295)
- "There is more and more evidence that if you have a true duct disruption, a distal, ideally splenic-preserving distal pancreatectomy early is better treatment for grade 3 pancreatic injuries." — Richard Falcone (clinical) [Ep 2 · 22:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1320)
- "ERCP has advantages (potentially therapeutic with stent placement) and disadvantages (risk of inducing pancreatitis by injecting dye), while MRCP doesn't have the pancreatitis risk." — Richard Falcone (clinical) [Ep 2 · 23:20](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1400)
- "Conservative management of pancreatic duct disruption can work and pseudocysts are manageable and drainable, but this approach takes longer with more TPN time and longer hospital length of stay compared to early pancreatectomy." — Richard Falcone (clinical) [Ep 2 · 24:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1450)
- "Centers that perform frequent pancreatic operations and are comfortable with laparoscopic distal pancreatectomy are more likely to have good outcomes with surgical management of pancreatic trauma." — Richard Falcone (opinion) [Ep 2 · 25:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1500)
- "There is more of a trend toward considering operating on pancreatic duct injuries more frequently, and if you're going to do it, you want to do it within the first 24 hours." — Richard Falcone (clinical) [Ep 2 · 26:40](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1600)
- "If you go in to operate on pancreatic trauma and find parenchymal injury but not ductal disruption, you should just drain and get out rather than proceeding with distal pancreatectomy." — Richard Falcone (clinical) [Ep 2 · 27:28](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1648)
- "There is literature showing that if you see someone who looks like you and is from the same neighborhood, you're less likely to be suspicious of child abuse even with the same injury pattern, compared to someone from a lower socioeconomic group or different racial/ethnic background." — Richard Falcone (host_summary) [Ep 2 · 28:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1730)
- "Cincinnati Children's was more likely to do skeletal surveys and involve social services for low socioeconomic status or minority children with head injuries compared to middle/upper class non-minority families." — Richard Falcone (clinical) [Ep 2 · 29:40](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1780)
- "Abuse happens in all races and all socioeconomic bands, though economic stress does add some risk." — Richard Falcone (epidemiological) [Ep 2 · 30:20](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1820)
- "Cincinnati Children's implemented universal screening: any child under 2 admitted with a head injury from an unwitnessed mechanism (not witnessed publicly, not motor vehicle collision) gets skeletal survey and social work evaluation." — Richard Falcone (clinical) [Ep 2 · 30:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1850)
- "After implementing universal screening criteria for non-accidental trauma, the percentage of positive abuse cases remained at nearly 50%, despite evaluating more children, indicating the protocol was finding previously missed abuse cases." — Richard Falcone (epidemiological) [Ep 2 · 31:40](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1900)
- "A screening test that gives nearly a 50% positive rate of abuse is more productive than most screening tests we do for other things." — Richard Falcone (opinion) [Ep 2 · 32:30](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1950)
- "Families find universal non-accidental trauma screening more reassuring because it's easier to say 'we do this for every family with this type of injury' rather than making it seem like a judgment about the specific family." — Richard Falcone (clinical) [Ep 2 · 33:09](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1989)
- "Ophthalmologic exams are not routine but are obtained if the skeletal survey is positive or if there are other concerning findings like bruising or abnormal head findings that don't fit the given story." — Richard Falcone (clinical) [Ep 2 · 33:23](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2003)
- "The Pediatric Emergency Care Research Network published criteria in Annals of Emergency Medicine 2013 identifying children at very low risk (0.1% chance) of clinically important blunt abdominal injuries: no abdominal wall trauma, GCS 14-15, no abdominal tenderness, no thoracic wall trauma, no abdominal pain, no altered breath sounds, and no vomiting." — Richard Falcone (host_summary) [Ep 2 · 35:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2100)
- "If the very low risk criteria were followed strictly and everyone else was scanned, it would actually recommend more CTs than pediatric trauma centers are currently doing." — Richard Falcone (host_summary) [Ep 2 · 36:24](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2184)
- "Abnormal LFTs greater than 150-200 indicate a good chance of some sort of abdominal injury, but normal LFTs provide very little evidence that you're safe, so they may be useful as screening but not for ruling out injury." — Richard Falcone (clinical) [Ep 2 · 37:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2220)
- "Cincinnati Children's has gone away from getting LFTs, amylase, and lipase as routine; they only get them if there are other indications to scan (abdominal bruising, tenderness)." — Richard Falcone (clinical) [Ep 2 · 37:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2270)
- "Normal labs don't prove you don't have an abdominal injury, they just make us feel better and give a false sense of security." — Richard Falcone (opinion) [Ep 2 · 38:30](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2310)
- "Eric Scaife from Utah published that FAST was being used to screen low-risk kids but was giving false sense of security because of the low sensitivity of FAST, which is very user-dependent like any ultrasound test." — Richard Falcone (host_summary) [Ep 2 · 39:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2340)
- "FAST is great for hypotensive patients to determine if they have blood in their abdomen, which is the classic reason FAST was developed." — Richard Falcone (clinical) [Ep 2 · 39:40](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2380)
- "A negative FAST in a stable, healthy child may still miss injuries if you trust it too much." — Richard Falcone (clinical) [Ep 2 · 40:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2410)
- "At Cincinnati Children's, it has been 4-5 years since they used angiography/embolization for a solid organ injury, though they use it for pelvic trauma and other reasons." — Richard Falcone (clinical) [Ep 2 · 41:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2510)
- "Angiography for solid organ injuries is used more often at adult centers, and there has been a trend of embolizing when seeing a blush or bad injury rather than waiting to see how the patient does." — Richard Falcone (clinical) [Ep 2 · 42:30](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2550)
- "There is no good evidence that seeing a blush on imaging mandates intervention; a blush puts you at higher risk for needing intervention or transfusion but doesn't mean you will need it." — Richard Falcone (clinical) [Ep 2 · 43:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2590)
- "Dr. Stylianos's 1999 paper with the American Pediatric Surgical Association Trauma Committee was a landmark paper that changed how everyone managed spleen and liver trauma, and adult trauma surgeons followed pediatric surgeons' lead." — Richard Falcone (host_summary) [Ep 2 · 44:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2640)
- "Sean St. Peter and the Kansas City group published papers showing we can shorten bed rest windows: grade 1 and 2 solid organ injuries need at most overnight (12 hours), and maybe two nights for grade 3 or 4 injuries." — Richard Falcone (host_summary) [Ep 2 · 44:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2690)
- "By shortening bed rest for solid organ injuries, you can cut down significantly on length of stay without having readmissions or complications." — Richard Falcone (host_summary) [Ep 2 · 45:40](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2740)
- "You can mobilize children with solid organ injuries much more quickly from bed rest than originally outlined in Stylianos's paper, without the slow progression that was initially recommended." — Richard Falcone (clinical) [Ep 2 · 46:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2770)
- "There is growing evidence that very few grade 1 solid organ injuries, if any, are going to need a transfusion, so all the lab draws initially outlined in Stylianos's paper probably aren't necessary." — Richard Falcone (host_summary) [Ep 2 · 46:38](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2798)
- "Dennis Bensard's group from Colorado presented at Western Trauma Association proposing not doing any lab draws for solid organ injuries if the patient is clinically OK (not tachycardic, no pain, no vital sign changes), using labs totally as directed by physical findings." — Richard Falcone (host_summary) [Ep 2 · 47:20](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2840)
- "There is growing support for less lab draws, shorter length of stay, and less bed rest for solid organ injuries in children." — Richard Falcone (clinical) [Ep 2 · 48:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2890)
- "Cincinnati Children's protocol for solid organ injuries: grade 1 gets one 12-hour lab check, grade 2 gets two checks, grade 3 gets two checks or possibly a third based on clinical exam." — Richard Falcone (clinical) [Ep 2 · 48:28](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2908)
- "Grade 1 isolated spleen injuries may not even need hospital admission because they never get transfused and never have problems." — Richard Falcone (clinical) [Ep 2 · 49:10](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2950)
- "A multi-center prospective analysis published in 2012 examined pediatric trauma activation criteria, finding that the American College of Surgeons' 6 required criteria are generic, adult-based, and lack strong evidence." — Richard Falcone (host_summary) [Ep 2 · 50:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3000)
- "The multi-center study matched activation criteria to resources used (intubation, blood transfusion within 30 minutes, chest tube within 30 minutes, CPR within 30 minutes, OR within 60 minutes) rather than ultimate injuries sustained." — Richard Falcone (host_summary) [Ep 2 · 50:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3050)
- "The evidence-based trauma activation criteria identified were: penetrating wound to head/neck/torso, age-appropriate tachycardia or poor perfusion, receiving blood prior to arrival, systolic BP <90 or age-appropriate hypotension, 40 mL/kg fluid prior to arrival, respiratory distress or failure, and GCS ≤8." — Richard Falcone (host_summary) [Ep 2 · 52:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3120)
- "Using the evidence-based 8-9 criteria resulted in an over-triage rate of 39% and under-triage rate of only 10%, with the break point being around 8 or 9 criteria where adding more criteria lowers under-triage but increases over-triage." — Richard Falcone (host_summary) [Ep 2 · 53:00](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3180)
- "Brooke Lerner led a recent Journal of Trauma paper using the Delphi method to formally define high resources justifying trauma team activation, including ICU stay greater than 48 hours and other criteria from the initial multi-center work." — Richard Falcone (host_summary) [Ep 2 · 53:50](https://library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3230)
- "Traumatic brain injury caused over 837,000 visits, hospitalizations, and deaths in children in 2014." (host_summary) [Ep 3 · 0:11](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=11)
- "For a patient with small epidural hematoma, immediate neurosurgical consultation is needed to determine if surgical evacuation is required." — Pramod Pulaamba (clinical) [Ep 3 · 1:08](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=68)
- "Small epidurals may be managed with repeat CT in several hours or clinical observation for deterioration before operating." — Pramod Pulaamba (clinical) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=85)
- "ICP monitoring should be discussed with neurosurgeons for patients being managed for potential intracranial pressure issues." — Pramod Pulaamba (clinical) [Ep 3 · 1:40](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=100)
- "Invasive blood pressure monitoring is needed for accurate blood pressure identification in patients with intracranial hypertension." — Pramod Pulaamba (clinical) [Ep 3 · 1:58](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=118)
- "Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure." — Pramod Pulaamba (clinical) [Ep 3 · 2:10](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=130)
- "Most guidelines suggest keeping CPP greater than 45 as the minimal acceptable, sometimes 55 in children." — Pramod Pulaamba (host_summary) [Ep 3 · 2:25](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=145)
- "ICP above 20 may require ongoing treatment and/or reevaluation with imaging." — Pramod Pulaamba (clinical) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=160)
- "Acute intracranial hypertension may first manifest as dilation of the ipsilateral pupil or progressive bradycardia with hypertension." — Pramod Pulaamba (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=175)
- "Acute ICP management includes raising the head of bed to improve venous drainage, providing oxygen, and bag valve masking." — Pramod Pulaamba (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=195)
- "Hyperventilation to PCO2 of around 35 helps vasoconstrict the brain and create space in acute ICP crisis." — Pramod Pulaamba (clinical) [Ep 3 · 3:35](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=215)
- "If an ICP drain is present, opening it to evacuate fluid and reduce pressure is a first-line intervention." — Pramod Pulaamba (clinical) [Ep 3 · 3:55](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=235)
- "3% normal saline at 5 mL per kilogram will generally increase serum sodium by 3 to 5 mEq per liter." — Pramod Pulaamba (clinical) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=250)
- "3% normal saline has an osmolarity limit of 360 millimoles compared to Mannitol's 320 millimoles." — Pramod Pulaamba (clinical) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=270)
- "Hypotension in the context of closed head injury is a very poor prognosticator and should be avoided at all costs." — Pramod Pulaamba (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=285)
- "In older children and teenagers, systolic blood pressure should be kept above 90 or 95; younger children should use age-appropriate norms." — Pramod Pulaamba (clinical) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=300)
- "Norepinephrine can be used to drive up blood pressure to maintain cerebral perfusion." — Pramod Pulaamba (clinical) [Ep 3 · 5:20](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=320)
- "Based on the most recent guidelines in Pediatric Critical Care Medicine, there is no evidence that 3% saline is better than Mannitol or vice versa." — Pramod Pulaamba (host_summary) [Ep 3 · 5:30](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=330)
- "Mannitol's diuretic effect can be difficult to control and may lead to hypotension." — Pramod Pulaamba (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=345)
- "Mannitol's first effect within 15 to 20 minutes is changing blood vessel rheology to allow freer passage through cerebral circulation and improve oxygen delivery; the diuretic effect is secondary and occurs afterwards." — Pramod Pulaamba (clinical) [Ep 3 · 5:55](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=355)
- "The dose of Mannitol is 0.5 g to 1 g per kilogram." — Pramod Pulaamba (clinical) [Ep 3 · 6:13](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=373)
- "There is no role for steroids in pediatric traumatic brain injury." — Pramod Pulaamba (guideline) [Ep 3 · 6:33](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=393)
- "Steroids are no longer considered effective therapy for suspected spinal cord injury and may cause detriment." — Pramod Pulaamba (guideline) [Ep 3 · 6:42](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=402)
- "Decompressive craniectomy is an emerging option for patients with diffuse axonal injury and very difficult to control ICP where there is no true surgical lesion to decompress." — Pramod Pulaamba (clinical) [Ep 3 · 7:01](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=421)
- "Patients with persistently elevated ICP above 20 with higher spikes will slowly deteriorate to the point where they are not salvageable." — Pramod Pulaamba (clinical) [Ep 3 · 7:30](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=450)
- "In decompressive craniectomy, the bone is preserved and can be replaced after things settle down." — Pramod Pulaamba (clinical) [Ep 3 · 7:50](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=470)
- "Based on the 3rd iteration of Management of Traumatic Brain Injury in Children published in Pediatric Critical Care Medicine, there is still no clear consensus that decompressive craniectomy improves outcomes." — Pramod Pulaamba (host_summary) [Ep 3 · 8:15](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=495)
- "Major trauma centers across North America are using decompressive craniectomy more frequently." — Pramod Pulaamba (opinion) [Ep 3 · 8:40](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=520)
- "CT scan is preferred in acute situations with very acute presentation of increased ICP because it provides the best information for determining need for OR or drain placement." — Pramod Pulaamba (clinical) [Ep 3 · 9:08](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=548)
- "MRI is used after the first 48 hours once the patient is stable and ICP spikes are controlled, primarily as a prognosticator." — Pramod Pulaamba (clinical) [Ep 3 · 9:30](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=570)
- "MRI provides useful information for counseling families and directing care plans when injury is very severe." — Pramod Pulaamba (clinical) [Ep 3 · 9:50](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=590)
- "Repeat MRI in a week's time gives the true extent of injury and allows more meaningful discussions about level of disability." — Pramod Pulaamba (clinical) [Ep 3 · 10:05](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=605)
- "CT head scan can be completed in 5 minutes versus 20-30 minutes for MRI, making CT preferable for critical patients." — Pramod Pulaamba (clinical) [Ep 3 · 10:17](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=617)
- "Sympathetic storming is thought to occur because of an imbalance of the sympathetic and parasympathetic nervous systems as a result of head injury." — Pramod Pulaamba (clinical) [Ep 3 · 10:55](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=655)
- "Untreated sympathetic storming can lead to secondary brain injury or potentiate ongoing injury." — Pramod Pulaamba (clinical) [Ep 3 · 11:15](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=675)
- "Hyperventilation during sympathetic storming leads to vasoconstriction which could lead to cerebral hypoxia and further cellular injury." — Pramod Pulaamba (clinical) [Ep 3 · 11:30](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=690)
- "Hypertension during sympathetic storming could lead to hemorrhage within areas of the brain." — Pramod Pulaamba (clinical) [Ep 3 · 11:50](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=710)
- "Arrhythmias during sympathetic storming can lead to hemodynamic instability and hypoperfusion, worsening head injury." — Pramod Pulaamba (clinical) [Ep 3 · 12:05](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=725)
- "Neurogenic pulmonary edema is sometimes common in patients with sympathetic storming, leading to hypoxia and difficult ventilation." — Pramod Pulaamba (clinical) [Ep 3 · 12:20](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=740)
- "The cornerstone of sympathetic storming treatment is sedation and pain control, usually accomplished with narcotics and/or benzodiazepines as first-line medications." — Pramod Pulaamba (clinical) [Ep 3 · 12:40](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=760)
- "Bromocriptine acts on the hypothalamus to help reduce hyperthermia, diaphoresis, and blood pressure in sympathetic storming." — Pramod Pulaamba (clinical) [Ep 3 · 12:55](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=775)
- "Oxycodone has been used for its longer-acting effect for pain control in sympathetic storming." — Pramod Pulaamba (clinical) [Ep 3 · 13:08](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=788)
- "Propranolol can help control arrhythmias and lower blood pressure in sympathetic storming." — Pramod Pulaamba (clinical) [Ep 3 · 13:08](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=788)
- "Clonidine is an alpha-2 agonist that can reduce levels of catecholamines throughout the body and reduce ongoing sympathetic storm." — Pramod Pulaamba (clinical) [Ep 3 · 13:08](https://library.globalcastmd.com/watch/traumatic-brain-injury-1942?t=788)

## Changelog
- Sep 16: 3 items added automatically

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