Hey guys, no surgeons, or docs at the hospital (other than a family practice doc covering). I was at home when I heard over the radio that there had been a rollover accident.

I ran over to the hospital in time to see a pickup backing up. In the truck bed were 2 guys, 1 was fine (relatively), the other was unconscious and bleeding profusely from the front of his head. Apparently they had both been in the back of the pickup and had been ejected - no crush injuries.

I jumped in the back of the truck, the unconscious guy had fixed/dilated pupils, irregular RR, decerebrate posturing. I do a quick check in the pickup, find some abdominal abrasions, do a crappy version of a FAST scan, see possible blood. Vitals are ok, I don't want to tube him if I don't have to, because his airway is a mess. Cspine, on the backboard, I have him taken straight to our ambulance - really there isn't anything we can do for him at our hospital, he has to get to a better place ASAP.

I ride in the back, where I place IV's etc, have him on a NRB. It's an hour away to the next hospital. He's stable the whole time. We get there, I reassess, decide to intubate now that I have some resources.

After intubating (8 vec, 10 midaz - it's what the mex hospital had in their ER) I set the vent (which was difficult to get going) as follows: AC 16 TV 500 PEEP 5 FiO2 100% I:E 1:2.5. *I was trying to get some mild hypocapnea to decrease metabolic requirements etc*.

The guy looked to weigh about 90-100kg.

I get back here, start reading TBI studies on the internet, found out that hypocapnea is no longer recommended for acute TBI as of 2010 (!!!)

Here's my disclaimer: I do NOT do neuro, nor have I done any since I graduated school (in 2010); it's one of the only areas of anesthesia that I don't do here in Mexico or in the US.

I know I didn't handle this as well as I could have, so I need some tips, tricks, hints from any of you guys that do neuro. Anything you've learned that would help, any drug combos, things I could get to prepare better for the next one - more of a stabilize/transport kind of thing, since the most we'd do surgically at our hospital is place some burr holes.


edit: I ordered (almost presciently) some mannitol a few weeks ago, but it hasn't arrive at the hospital yet.