Prehospital Target BP for TBI Management - HackMD

ATLS 9th ed

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ATLS 10th ed

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TCCC Guideline (2024)

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637731/
Excellence in Prehospital Injury Care (EPIC) Traumatic Brain Injury Study

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TBI傷患在抵達醫院接受決定性處置前，在院前適切的評估與處置，將是改善預後的關鍵。也因為大腦組織容易面臨缺血性的風險，院前處置主要在減少這種繼發性損傷。根據TECC最新指引，若傷患懷疑有中重度腦損傷(Moderate to Severe TBI)時，建議復甦過程將血壓維持在100-110mmHg以上，這樣或可避免當腦損傷產生顱內壓上升時，低血壓策略反而造成腦灌流不足。

然而，在現場要運用傳統的GCS分數評估中重度腦損傷恐非易事。所以若傷患有明顯頭部損傷證據(如顱顏瘀青、開放性傷口、或口鼻出血等)或暴露在爆炸現場，且合併有意識障礙無法遵從指令時，我們可以暫時將其視為中重度TBI病患，並依據前述建議來進行急救處置。