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Hypertonic sodium solutions versus mannitol in reducing ICP in traumatic brain injury

Report by: Annette Rickard, SpR Emergency Medicine

Search checked by: Tony Kehoe, Consultant Emergency Medicine

Institution: Derriford Hospital, Plymouth, UK

Three-part question

In (patients with traumatic brain injury (TBI) and signs of raised intracranial pressure (ICP)) are (hypertonic sodium solutions better than mannitol) at (reducing morbidity and mortality)?

Clinical scenario

A 54-year-old female pedestrian has been hit by a bus. She is brought into the emergency department (ED) by ambulance. Her Glasgow Coma Score (GCS) is 13 on arrival, and examination reveals an isolated head injury with a haematoma over the left occiput. CT confirms a right frontal contusion with subdural and subarachnoid haemorrhage and a fracture of the left temporal and occipital bones. There is midline shift to the left. On return to the ED, her right pupil appears dilated and her GCS is now 10 (E2M4V4). The neurosurgical registrar is in theatre for the next 20 min. …

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