Traumatic brain injury: Where do we stand with ketamine and hyperventilation?

Abstract

A 29-year-old man on his bicycle is hit by a taxi cab despite being in a New York City designated bike lane. The rider does not have a helmet on and sustains a left tibia/fibula open fracture and a large bleeding scalp laceration. The first responders place a neck collar on, start an intravenous line, and call the trauma emergency department (ED) at Bellevue Hospital to report their assessment at the site of the accident. Above all, he is unconscious, with bilateral breath sounds, strong pulses, and no apparent abdominal or chest trauma. With a Glasgow Coma Scale score less than 8, the anesthesiologist is called to intubate the patient to both protect his airway and initiate neuroresuscitation. Total body computed tomography (CT) scan is consistent with the orthopedic trauma discovered on examination and a traumatic brain injury with a parietal subarachnoid hemorrhage and midline shift. The Glasgow Coma Scale (GCS) looks at traumatic brain injury within 48 h and describes the severity.