Page 100 - ATP-P 11th Ed

Signs and Symptoms of Elevated Intracranial Pressure
a. GCS<8 and suspected TBI
SECTION 1 b. Rapid decline in mental status
c. Fixed dilated pupils(s)
d. Cushing’s triad hemodynamics (hypertension, bradycardia, altered respirations)
e. Motor posturing (unilateral or bilateral)
f. Penetrating brain injury and GCS <15
g. Open skull fracture
Hypertonic Saline (HTS) Protocol (goal Na 140–165meq/L)
a. 3% HTS: 250–500mL bolus, then 50mL/hr infusion, rebolus as needed for clinical signs
b. 7.5% HTS: decrease above doses by 50%
c. 23.4%: dilute to 3% and use as above. If unable to dilute, can be given as 30mL bolus
and re-dose as needed.
d. Central venous line (CVL) preferred for 3% (can be given initially via peripheral
IV/IO)
e. CVL REQUIRED for 7.5% or higher concentration
Military Acute Concussion Evaluation 2 (MACE 2) Form, 2021
Open the attachment on the side menu or open the below link to print or fill out electronically.
https://www.health.mil/Reference-Center/Publications/2020/07/30/Military-Acute-
Concussion-Evaluation-MACE-2
MHS Progressive Return to Activity Following Acute Concussion/Mild TBI
Open the attachment on the side menu or open the below link to print or fill out electronically.
https://jts.health.mil/assets/docs/cpgs/Progressive_Return_to_Activity_Following_
Acute_Concussion_mTBI_Clinical_Recommendation_2021.pdf

90 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 91