- Hypoxia and hypotension are harmful – even for a short time
Irreversible brain damage can occur in TBI patients after only four minutes of anoxia, which can be caused by a compromised airway, altered respiratory patterns from the head injury, or lung injury in multi-system trauma. Use pulse-oximetry, skin color, and respiratory rate to assess adequate oxygenation. Administer oxygen via nasal cannula, non-rebreather mask, or bag valve to maintain a pulse-ox reading of at least 95%.
Cerebral oxygen delivery is also compromised by hypotension, which is associated with poor outcomes after even transient episodes. Hypotension caused directly by a head injury is a rare and ominous finding; it is more often caused by shock associated with other injuries. Administer IV fluids and titrate blood pressure to 90 – 100 mmHG systolic in head injured patients who are hypotensive.