The 2023 – 2024 Trauma Webinar Series – Part Seven: Traumatic Brain Injury – Point of Injury Through the First 24 Hours



Date & Location
Wednesday, March 13, 2024, 12:00 PM - Saturday, March 13, 2027, 1:00 PM

Credits
AMA PRA Category 1 Credits™ (1.00 hours), ANCC Nursing Contact Hours (1.00 hours), CME-Designated Participation Credit (1.00 hours)

Overview

Please join us for a review of guidelines for the management of traumatic brain injury starting from the point of injury in the pre-hospital setting up to the first 24 hours. The discussion will include considerations for care and lateralizing maneuvers leading toward definitive care. This webinar will focus on the pre-hospital setting, community emergency medicine setting, transfer considerations, and a brief overview of definitive care.

Presenter

Kris Halliwell MSN, APRN, ACNPC-AG, NRP, CCRN, CFRN, TCRN 
Nurse Practitioner, Neurology Critical Care
Dartmouth Hitchcock Medical Center, Lebanon, NH


Learning Objectives
At the conclusion of this learning activity, participants will be able to:

  1. Describe two management strategies for Traumatic Brain Injury (TBI).
  2. Discuss the indications that could require a transfer to a higher care setting for patients with TBI.

Accreditation

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours. 

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

Registration/Requirements for Successful Completion
You may claim credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Click the Register tab above. If you are not logged into your account, you will need to log in. Use the Forgot Your Password? button if you need to reset your password.
  2. Register for the activity.
  3. Click the Content/Tests tab and then View Content to view the recording. View the entire presentation.
  4. Complete the Post-Test (attestation - return to the Content/Tests tab to find it).
  5. Click the Complete Evaluation button, or click My Account in the menu bar; then click Evaluations.
  6. Complete and Submit the Evaluation.

Bibliographic Sources

  • Brain Trauma Foundation. (2016, September 30). Guidelines for the Management of Severe TBI. Retrieved March 2024, from Brain Trauma Foundation: https://braintrauma.org/coma/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed

  • CDC. (2023, September 7). TBI Data. Retrieved March 2024, from Traumatic Brain Injury & Concussion: https://www.cdc.gov/traumaticbraininjury/data/index.html

  • Chesnut, R., Marshall, L., Klauber, M., Blunt, B., Baldwin, N., Eisenberg, H., . . . Foulkes, M. (1993, February). The role of secondary brain injury in determining outcome from severe head injury. Journal of Trauma, 34(2), 216-222. doi:10.1097/00005373-199302000-00006

  • Debenham, S., Sabit, B., Saluja, R., Lamoureux, J., Basjarowicz, P., Maleki, M., & Marcoux, J. (2011, November). A critical look at phenytoin use for early post-traumatic seizure prophylaxis. The Canadian Journal of Neurological Science, 38(6), 896-901. doi:10.1017/s031716710001249x

  • Dewan, Y., Komolafe, E., Mejia-Mantilla, Perel, P., Roberts, I., Skakur, H., & Collaborators, C.-3. (2012, June). CRASH-3 -tranexamicacid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial. Trials, 21(13). doi:10.1186/1745-6215-13-87

  • Guangyu, L., Zhu, L., Xingdong, W., Zhang, H., & Li, Y. (2019, September). DecompressiveCraniectomyfor Patients with Traumatic Brain Injury: A Pooled Analysis of Randomized Controlled Trials. World of Neurosurgery, Epub, 135-148. doi:10.1016/j.wneu.2019.08.184

  • Inaba, K., Menaker, J., Branco, B., Gooch, J., okoye, O., Herrold, J., . . . Demetriades, D. (2013, March). A prospective multicenter comparison of levetiracetamversus phenytoin for early posttraumatic seizure prophylaxis. The Journal of Trauma and Acute Care Surgery, 74(3), 766-771. doi:10.1097/TA.0b013e3182826e84

  • Jeremitsky, E., Omert, L., Dunham, C., Protetch, J., & Rodriguez, A. (2003, February). Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. Journal of Trauma, 54(2), 312-319. doi:10.1097/01.TA.0000037876.37236.D6

  • Jeremitsky, E., Omert, L., Dunham, C., Wilberger, J., & Rodriguez, A. (2005, January). The impact of hyperglycemia on patients with severe brain injury. Journal of Trauma, 47-50. doi:10.1097/01.ta.0000135158.42242.b1

  • Jones, K., Puccio, A., Harshman, K., Falcione, B., Benedict, N., Jankowitz, B., . . . Darby, J. (2008, October). Levetiracetamversus phenytoin for seizure prophylaxis in severe traumatic brain injury. Neurosurgical Focus, 25(4). doi:10.3171/FOC.2008.25.10.E3

  • Klein, P., Phillip, D., Natale, J., Levine, Z., Nogay, C., Sandoval, F., . . . McCarter, R. (2012, July). Results of phase II pharmacokinetic study of levetiracetamfor prevention of post-traumatic epilepsy. Epilepsy & Behavior, 24(4), 457-461. doi:10.1016/j.yebeh.2012.05.011.

  • National EMS Data. (2022, November 4). 2021 NEMSIS National Data Report. Retrieved March 2024, from https://nemsis.org/2021-nemsis-national-ems-data-report/

  • Pechadre, J., Beudin, P., Eschalier, A., Trolese, J., & Rihoux, J. (1991, July-August). A comparison of central and peripheral effects of cetirizine and loratadine. The Journal of International Medical Research, 19(4), 289-295. doi: 10.1177/030006059101900401

  • Roberts, I., Shakur, H., Coats, T., Hunt, B., Balogun, E., Barnetson, L., . . . Guerriero, C. (2013, March). The CRASH-2 trial: a randomisedcontrolled trial and economic evaluation of the effects of tranexamicacid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health technology Assessment, 17(10), 1-79. doi:10.3310/hta17100

  • Shibahashi, K., Sugiyama, K., Okura, Y., Tomio, J., Hoda, H., & Hamabe, Y. (208, December). Defining Hypotension in Patients with Severe Traumatic Brain Injury. World of Neurosurgery, Epub, e667-e674. doi:10.1016/j.wneu.2018.08.142

  • Spaite, D., Hu, C., Bobrow, B., Chikani, V., Barnhart, B., Gaither, J., . . . Sherrill, D. (2017, Jnauary). The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Annals of Emergency medicine, 69(1), 62-72. doi:10.1016/j.annemergmed.2016.08.007

  • Szaflarski, J., Sangha, K., Lindsell, C., & Shutter, L. (2010, April). Prospective, randomized, single-blinded comparative trial of intravenous levetiracetamversus phenytoin for seizure prophylaxis. NeurocriticalCare, 12(2), 165-172. doi:10.1007/s12028-009-9304-y

  • Szaflarski, J., Sangha, K., Lindsell, C., & Shutter, L. (2010, April). Prospective, randomized, single-blinded comparative trial of intravenous levetiracetamversus phenytoin for seizure prophylaxis. NeurocriticalCare, 12(2), 165-172. doi:10.1007/s12028-009-9304-y

  • Temkin, N., Dikmen, S., Wilensky, A., Keihm, J., Chabal, S., & Winn, H. (1990, August). A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. New England Journal of Medicine, 497-502. doi:10.1056/NEJM199008233230801

  • Vespa, P., Nuwer, M., Nenov, V., Ronne-Engstrom, E., Hovda, D., Bergsneider, M., . . . Becker, D. (1999, November). Increased incidence and impact of nonconvulsiveand convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. Journal of Neurosurgery, 91(5), 750-760. doi:10.3171/jns.1999.91.5.0750

  • Wilson, C., Burks, J., Rodgers, R., Evans, R, Bakare, A., & Safavi-Abbasi, S. (2018, February). Early and Late Posttraumatic Epilepsy in the Setting of Traumatic Brain Injury: A Meta-analysis and Review of Antiepileptic Management. World Neurosurgery, Epub, e901-e906. doi:10.1016/j.wneu.2017.11.116

  • Wohns, R., & Wyler, A. (1979, Octobere). Prophylactic phenytoin in severe head injuries. Journal of Neurosurgery, 51(4), 507-509. doi:10.3171/jns.1979.51.4.0507

  • Zanza C, PiccolellaF, RaccaF, RomenskayaT, LonghitanoY, FranceschiF, SavioliG, BertozziG, De Simone S, CipolloniL, La RussaR. Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity. Healthcare (Basel). 2022 Mar 17;10(3):566. doi: 10.3390/healthcare10030566. PMID: 35327044; PMCID: PMC8949520.

  • ZeilerFA, TeitelbaumJ, West M, Gillman LM. The ketamine effect on ICP in traumatic brain injury. NeurocritCare. 2014 Aug;21(1):163-73. doi: 10.1007/s12028-013-9950-y. PMID: 24515638

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
CE Office
Dartmouth Health
[email protected]