Page 146 - JSOM Spring 2023

23.4% hypertonic saline: a tactical option for the hypertonic saline. However, this fluid bears a tactical burden of
3
management of severe traumatic brain injury with weight (~570g) and pack volume (~500 cm ). Thus, 23.4% hyper-
impending or ongoing herniation tonic saline is an attractive option, because it has a lighter weight
3
Erik DeSoucy, DO; Kelsey Cacic, MD; Brian Staak, MD; Chris (80g) and pack volume (55 cm ), and it provides a similar osmotic
Petersen; David Van Wyck, DO; Venkatakrishna Rajajee, MBBS; load per dose. Current literature supports the use of 23.4% hy-
John Dorsch, DO; Stephen Rush, MD pertonic saline in the management of acute TBI, and evidence in-
dicates that it is safe to administer via peripheral and intraosseous
J Spec Oper Med. 21(2):25–28. cannulas. Current combat medic TBI treatment algorithms should
There are limited options available to the combat medic for be updated to include the use of 23.4% hypertonic saline as an
management of traumatic brain injury (TBI) with impending or alternative to 3% and 5% solutions, given its effectiveness and
ongoing herniation. Current pararescue and Tactical Combat Ca- tactical advantages.
sualty Care (TCCC) guidelines prescribe a bolus of 3% or 5%

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144 | JSOM Volume 23, Edition 1 / Spring 2023