If a casualty has a moderate/severe TBI, what is an appropriate action to take?

In the case of a casualty suffering from moderate to severe traumatic brain injury (TBI), the primary focus is on managing intracranial pressure (ICP) and ensuring adequate cerebral perfusion. Administering hypertonic saline can help reduce cerebral edema by drawing water out of the brain tissue, subsequently decreasing ICP. Hyperventilation is also a strategy used in acute management to lower carbon dioxide levels in the blood, which can induce vasoconstriction of cerebral blood vessels, further helping to manage ICP.

Elevating the head at 45 degrees is typically beneficial in some cases of TBI as it can help with venous drainage from the brain and reduce ICP. However, it does not directly address other crucial factors that hypertonic saline and hyperventilation manage more effectively in a severe scenario.

While providing oxygen and keeping the casualty flat may help in certain situations, it does not address the specific complications that arise from severe TBI, such as the need to control ICP and manage cerebral perfusion pressure, which are critical for improving outcomes.

Therefore, the appropriate action in managing moderate to severe TBI is to administer hypertonic saline and consider hyperventilation techniques to control intracranial pressure effectively.