Low Systolic BP "fad" and TBI

[Mike Smertka]

  While reading the ongoing debate about ketamine and etomidate a comment was made about lower systolic pressures being a "fad." It was also commented on the effects this would have on an injured brain. 
   
  I was understanding that the lower (70-80) systolic pressures was meant as a temporary therapy for resuscitaion, particularly for the purpose of reducing blood loss, prior to surgical control of bleeding. I assumed this was meant to be used during the out-of-hospital setting and in the Emergency Department, not as a long term recovery therapy in a surgical ICU or recovery. I also concluded that if a hernation of the brain was imminent or already the case, hypovolemia specifically due to loss, (opening in vascular container) would have to be addressed simultaneously if not prior. I also think that an emergency craniotomy would idealy reduce pressure enough to facilitate using a lower systolic pressure. In addition I was also under the impression that once bleeding was controlled that the theraputic end point for BP would be as close to normal as possible for the individual, not the 70-80 systolic. 
   
  Please could somebody let me know if I am wrong or missing a key piece of information?
   
  I have read the 7th edition ATLS and in the early part of the book it mentions that it details common accepted practice not cutting edge medicine.
   
  Thanks,
  Mike 

       
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