Table 1 – Mean arterial pressure targets

Use vasopressors / inotropes (preferably noradrenaline if central access possible, otherwise dopamine) to maintain MAP if needed.

Age	MAP
<2 years	>55mmHg
2–6 years	>60mmHg
>6 years	>70mmHg

Environment

• The transfer of severe traumatic brain injury is time-critical because the patient might need urgent surgery to avoid death and/or neurological morbidity. Early identification and urgent transfer to a neurosurgical unit is the key for the best outcomes in these children; once identified, the patient needs to be transferred to the Major Trauma Centre without any delay. Please call NCS to coordinate transfer and advice from the relevant specialists.

Checklist before transfer of a head injured child

• Ensure the patient is stable: consider items on transfer checklist
• Ensure the NCS consultant knows the expected time of arrival
• Ensure adequate escort: airway competent doctor (usually anaesthetist) and appropriately trained paramedic / nurse, or the Major Trauma Outreach Service
• Minimise the number of trolley transfers, 15° head up tilt
• Prepare boluses of IV anaesthetic before manipulation or movement if suspected raised ICP
• Use mannitol 0.5–1.0 g/kg or hypertonic saline (2–4 ml/kg if 5%) if raised ICP on CT or pupillary inequality
• Ensure adequate monitoring: ECG, SpO2, invasive BP (or automatic NIBP), ETCO2
• Check ABG and Hb prior to transfer. Catheterise before transfer
• Check spare intubation equipment, check oxygen cylinders, self-inflating resuscitation bag
• Check emergency drugs, IV fluids, IV access equipment, inotropes