What Really Kills the Brain After TBI (and How to Stop It)

Learn how paramedics can protect the brain after TBI flow using simple, evidence-based steps. When managing traumatic brain injury (TBI) in the field, most clinicians think it’s just “scoop and run.” But what if a few simple, evidence-based actions could actually protect the brain before you reach the hospital? In this episode I will break down a prehospital TBI protocol you can apply with standard ambulance equipment — no fancy gear or advanced drugs needed. Learn how to: 🧠 Maintain Mean Arterial Pressure (MAP) to preserve Cerebral Blood Flow (CBF) 💨 Control ETCO₂ to prevent CO₂-related spikes in intracranial pressure 🔥 Keep your patient warm to improve cerebral perfusion 💉 Provide early analgesia to reduce stress and ICP 🫁 Master the SALAD airway technique for blood-filled or contaminated airways I will also explore the key physiology behind the equation: CBF = (MAP – ICP) ÷ CVR — and why understanding it can change your practice. Whether you’re a paramedic student, critical care clinician, or pre-hospital educator, this video gives you the physiology, practical steps, and airway tricks to truly buy the brain some time. References: ------------------------------------------- Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15. 🔗 https://doi.org/10.1227/NEU.000000000... Anderson ID, Stewart RM, Hasler RM, et al. Prehospital management of traumatic brain injury. J Trauma Acute Care Surg. 2023;94(3):512–520. 🔗 https://doi.org/10.1097/TA.0000000000... Davis DP, Idris AH, Sise MJ, Kennedy F, Eastman AB, Vilke GM, et al. Early ventilation and outcome after severe traumatic brain injury. J Trauma. 2008;65(5):1038–1044. 🔗 https://doi.org/10.1097/TA.0b013e3181... Vella MA, Crandall ML, Patel MB. Acute management of traumatic brain injury. Surg Clin North Am. 2017;97(5):1015–1030. 🔗 https://doi.org/10.1016/j.suc.2017.06... Weaver AA, McDonald CC, D’Alonzo BA, et al. The effect of hypothermia on cerebral blood flow and resistance. Neurocrit Care. 2015;23(1):72–80. 🔗 https://doi.org/10.1007/s12028-014-01... DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomit and secretions using the suction-assisted laryngoscopy and airway decontamination (SALAD) technique. West J Emerg Med. 2017;18(1):117–120. 🔗 https://doi.org/10.5811/westjem.2016.... Robinson BRH, Pohlman TH, McKinley BA, et al. Analgesia and sedation in the prehospital setting for head injury: balancing pain control and cerebral perfusion. Prehosp Emerg Care. 2019;23(3):341–348. 🔗 https://doi.org/10.1080/10903127.2018... Hall JE, Hall ME. Guyton and Hall Textbook of Medical Physiology. 15th ed. Philadelphia: Elsevier; 2021. Chapter 60, Cerebral Blood Flow, Cerebrospinal Fluid, and Brain Metabolism; p. 767–779. 🔗 https://www.elsevier.com/books/guyton...