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Primary survey and immediate threats
Time-critical stabilization priorities
Airway protection indications
Glasgow Coma Scale 8 or less
Refractory hypoxemia
Refractory hypercapnia
Recurrent vomiting with depressed consciousness
Agitation preventing safe evaluation or imaging
Cervical spine protection
Manual in-line stabilization during airway management
Rigid collar until clearance
Oxygenation targets
SpO2 94% to 98%
Avoid SpO2 under 90%
Ventilation targets
PaCO2 35 to 40 mmHg when stable
If herniation physiology, temporary PaCO2 30 to 35 mmHg until definitive therapy
Hemodynamic targets
SBP 110 mmHg or higher for age 15 to 49 years
SBP 100 mmHg or higher for age 50 to 69 years
SBP 110 mmHg or higher for age 70 years or older
Glucose targets
6 to 10 mmol/L
Avoid hypoglycemia
Avoid persistent hyperglycemia
Temperature targets
Normothermia
Avoid fever
Immediate escalation triggers
Unilateral fixed dilated pupil
Bilateral fixed dilated pupils
New focal neurologic deficit
Rapid decline in Glasgow Coma Scale
Cushing response
Refractory hypotension
Refractory hypoxemia
Seizure with persistent altered consciousness
Secondary brain injury prevention bundle
Neuroprotection bundle
Head and neck positioning
Head of bed 30 degrees
Neutral neck alignment
Avoid jugular venous compression
Sedation and analgesia goals
Ventilator synchrony
Control agitation and coughing
Reliable neurologic reassessment plan
Fluid strategy
Isotonic crystalloids
Avoid hypotonic fluids
Avoid dextrose boluses unless hypoglycemia
Oxygen delivery and anemia
Avoid hypoxemia
Consider transfusion threshold individualized to bleeding and oxygenation
Coagulopathy correction
Rapid reversal for intracranial hemorrhage with anticoagulant exposure
Platelet goal individualized for procedure and hemorrhage expansion risk
Intracranial hypertension and herniation first-pass actions
Suspected intracranial hypertension actions
Immediate nonpharmacologic measures
Optimize oxygenation and ventilation targets
Head elevation and neutral alignment
Analgesia and sedation for coughing and agitation
Maintain SBP target range
Hyperosmolar selection
Hypertonic saline favored with hypotension risk
Mannitol avoided with hypotension or hypovolemia
Hyperventilation constraints
Bridge therapy only for herniation physiology
Avoid prolonged prophylactic hyperventilation
Definitive pathway triggers
Neurosurgery activation for mass lesion or refractory ICP
Emergent CT head if not already obtained
ICU admission for invasive monitoring needs
Consultation, transfer, and monitoring
Team activation and destination
Trauma team activation for multi-system injury
Neurosurgery consultation for moderate to severe TBI
Transfer to neurosurgical center when indicated
Need for ICP monitor or EVD
Need for neurosurgical intervention
No local neurocritical care capability
Monitoring modalities
Continuous ECG
Continuous SpO2
Frequent noninvasive BP or arterial line
End-tidal CO2 for ventilated patients
Core temperature monitoring for ICU-level care
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.