Injury history
Structural severity records the high-water injury severity. Severe and critical injuries retain reduced cerebrovascular reserve even after active symptoms settle.
ACM EXTENDED / REFERENCE
Head injury assessment
Follow neurological findings together with perfusion and breathing.
01
Recognize deterioration
Reassess consciousness, pupils, breathing and circulation after head injury. Rising ICP can produce a Cushing response with increased vascular resistance, pressure support and a slower heart rate. Exhausted autonomic control can later make tone unstable or predominantly dilated; the full Cushing pattern does not have to appear first. Medication effects can also change consciousness or pupils, so review treatment history.
Active burden
Acute severity can fall toward zero in a stable mild or moderate injury. ICP returns toward its normal baseline, and a resolved concussion no longer continues generating deterioration.
Check recovery conditions
Assess oxygen delivery, ventilation, ICP and perfusion together. Severe structural injury adds a CPP minimum of 55 mmHg; critical injury adds 60 mmHg. A normal SpO₂ reading does not replace missing blood flow.
The clinical descriptor reference explains examination wording. See Traumatic brain injury for the broader system guide.
Sources and revision
TBI update checked at ACM Extended dev revision 98d18bb: acute recovery and structural history · autonomic changes and the vital pattern.
02
Check the available options
| Category / section | Option | Purpose |
|---|---|---|
ACM Extended: Systems > Systems | TBI model | Enables the structural and acute injury model, ICP, autoregulation, autonomic tone and osmotherapy behavior. |
ACM Extended: Neuro & TBI > Procedures | Allow Osmotherapy Bolus Actions | Enables the dedicated hypertonic saline and mannitol pushes. |
ACM Extended: Neuro & TBI > Tuning | Sodium ceiling (mEq/L) | Limits further osmotherapy benefit at high modeled sodium. |
03
Choose the correct product
Read the hypertonic saline and mannitol cards for route, dose, effects and restrictions. The dedicated push actions have their own current responses; their inventory concentrations do not predict the same response as the larger infusion bags.