Clinical Disease

trauma

Must-have

Polytrauma with Traumatic Brain Injury (TBI)

Anesthetic priorities when TBI coexists with hemorrhagic shock, cervical spine injury, and massive transfusion

Polytrauma with TBI demands simultaneous brain resuscitation (SpO2 ≥94%, SBP ≥100-110 mmHg, normocapnia, ICP <20-22 mmHg) and hemorrhagic shock resuscitation (1:1:1 transfusion, balanced hemostasis) under assumed cervical spine injury.

If you forget

Two patients, one brain — prevent secondary injury (oxygenation, ventilation, perfusion, temperature, glucose, seizure, ICP) while controlling hemorrhage.

Board trap

Classic follow-up: TBI patient with a positive FAST and falling MAP — do you go to CT head or the OR for laparotomy? Both proceed in parallel; the trap is letting neuro workup delay hemorrhage control, while ignoring the brain kills the patient after the bleeding is stopped.

Key numbers

SBP ≥100-110 mmHg until ICP measured
SpO2 ≥94% / PaO2 >60-80 mmHg
ICP target <20-22 mmHg; CPP 60-70 mmHg
ETCO2 35-40 mmHg
Rocuronium RSI 1.2 mg/kg IV
Calcium gluconate 3 g IV per 4 U blood products (or CaCl2 1 g IV per 4 U)
1:1:1 pRBC : FFP : platelets for massive transfusion

Reviewed Sep 16, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: ACS TQP TBI Best Practices 2024 · DAS Cervical Spine Airway 2024

Re-review cadence: 12 months from reviewed date.

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