Traumatic Brain Injury: Creating a Practice Protocol

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Quick action is essential for TBI cases and every team member must be well-trained in the required steps.

Because time is critical for TBI patients, the practice should have a protocol in place. Make protocol development a fun team exercise. During a team meeting, ask every team member to write on sticky notes each step he or she should take to handle a TBI situation, using one note per step. Then, ask each team member to stick his or her notes on a wall in step-by-step order. The team should decide if they need to add any missing steps. This exercise will also emphasize each team member’s role in aiding the patient and client.

Once the protocol is finalized, the team should role-play a TBI presentation.

Following is a suggested protocol:

  • The front-desk team greets the patient and client, recognizes the emergency situation, and visually assesses the patient: Is the patient conscious? Bleeding? Breathing? Having a seizure?
  • Often the client is extremely distraught; team members should calm him or her and offer to call friends or family.
  • One team member obtains the patient’s records and gathers patient and client information.
  • Veterinary technicians or assistants carry the patient to the examination or treatment room. Other veterinary technicians should prepare the necessary tools (eg, x-ray machine, IV catheters and fluids).  
  • The front-desk team members alert the veterinarian, who joins the technicians in evaluating the patient. They stabilize the patient, if possible, and create a treatment plan that includes a probable prognosis.
  • The veterinarian meets with the client and discusses the prognosis, including treatment options or euthanasia if the prognosis is extremely poor.
  • The veterinary technician reviews the treatment plan and the costs with the client.
  • The veterinary technician or a front-desk team member ensures the appropriate forms are signed and a deposit is collected.

Quick action is essential for TBI cases and every team member must be well-trained in the steps required to care for both the patient and the client.

Related Article: How to Normalize Emergencies in Practice

References Show
References
References: 
  1. Simpson SA, Syring R, Otto CM. Severe blunt trauma in dogs: 235 cases (1997-2003). JVECC. 2009;19(6):588-602.

  2. Syring RS, Otto CM, Drobatz KJ. Hyperglycemia in dogs and cats with head trauma: 122 cases (1997-1999). JAVMA. 2001;218(7):1124-1129.

  3. Freeman C, Platt S. Head Trauma. In: Platt S, Garosi L, eds. Small Animal Neurological Emergencies. London, UK: Manson Publishing; 2012:363-382.

  4. Fletcher DJ, Syring R. Traumatic Brain Injury. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2nd ed. Philadelphia, PA: Elsevier; 2015:723-727.

  5. Dewey CW, Fletcher DJ. Head Trauma Management. In: Dewey CW, ed. A Practical Guide to Canine & Feline Neurology. 2nd ed. Ames, IA: Wiley Blackwell Publishing; 2008:221-235.

  6. Sande A, West C. Traumatic Brain Injury: A review of pathophysiology and management. JVECC. 2010;20(2):177-190.

  7. DiFazio J, Fletcher DJ. Updates in the Management of the Small Animal Patient with Neurologic Trauma. Vet Clin North Am Small Anim Pract. 2013;43(3):915-940.

  8. Platt SR, Radaelli ST, McDonnell JJ. The prognostic value of the modified Glasgow Coma Scale in head trauma in dogs. JVIM. 2001;15(6):581-584.

  9. Roberts I, Yates D, Sandercock P. Effect of intravenous corticosteroids on death within 14 days in 10,008 adults with clinical significant head injury (MRC CRASH trial): Randomized placebo-controlled trial. Lancet. 2004;364(9442):1321-1328.

  10. Sturges B, LeCouteur R. Intracranial Hypertension.  In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:436-442.

Suggested Reading

Boss N. Educating Your Clients from A to Z: What to Say and How to Say It. 2nd ed. Lakewood, CO: AAHA Press; 2011.

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