Approach to traumatic brain injury Quiz: Ace Your Exams

A 46-year-old woman presents to the emergency department (ED) with a gunshot wound to the head. Emergency responders report that there was significant blood loss at the scene, she was unresponsive upon their arrival, and she was intubated en route to the ED for airway protection. In the ED, her temperature is 35.7 ºC (96.2 ºF), pulse is 145/min, blood pressure is 85/50 mmHg, and SpO2 is 100% on a ventilator. Primary survey demonstrates secured airway (intubated), bilateral breath sounds, faintly palpable distal pulses, and 2 large-bore IVs in place, GCS f 7 (no eye-opening, no verbal response, motor score 5) and no additional penetrating injuries are present. She is covered with warm blankets, fluid resuscitation is initiated, and the secondary survey is performed, demonstrating two gunshot wounds to the head with active oozing that is controlled with pressure; equal, round, and reactive pupils; and reduced strength in the bilateral upper extremities. A computed tomography (CT) head and basic labs are obtained, as demonstrated below. What is the most appropriate next step in management of this patient?

Laboratory value	Result
Serum chemistry
Sodium	137 mEq/L
Potassium	4.2 mEq/L
Chloride	108 mEq/L
Creatinine	0.78 mg/dL
BUN	18 mg/dL
Complete blood count
Leukocyte Count	18 g/dL
Hemoglobin	5.1 g/dL
Hematocrit	15.3 %
Platelet Count	225,000/mm3

https://www.sciencedirect.com/science/article/abs/pii/S1878875020306100