Could you please define the TBI contraindication for NSAID administration?

Question#: 603

Question:

Could you please define the TBI contraindication for NSAID administration?



Is it reasonable to treat a pt who fell and has hematoma on head with acetaminophen and ibuprofen assuming no other contraindications? (ie unaltered, no LOC, no neurological symptoms, no blood thinners, no bleeding, etc)



Or is it best to be prudent and withhold any NSAIDS with a pt who hit their head?



Thanks

Answer:

Hello,

Thank you for your MedicASK question.

The issue is that a TBI is impossible to diagnose in the field, and we can only go on suspicion, which includes MOI. Studies strongly suggest that patients with a minor mechanism of injury and no abnormalities on neurologic examination may still have significant subdural or epidural bleeding. As defined by Brain Injury Canada a traumatic brain injury is when the brain is damaged due to factors that exist outside of the body, including motor vehicle accidents, falls, assault and sports injuries.

There are inherent risks of providing NSAID therapy to any patient with a head trauma, as these medications can interfere with clotting and may contribute to bleeding from damaged cerebral vessels. During assessment there are several aspects that can be identified that may increase this risk; advanced age, headache, evident and visible injury, daily ASA and relative hypertension all combine to create a potential patient safety issue and we encourage you to err on the side of caution.

Due to the limitations of a prehospital setting, a "better safe than sorry" approach is best until proven otherwise at the emergency department, where better resources and testing are available to definitely rule out risks. Feel free to consult with the BHPs at any time.

Lastly, referring back to your question, it would be appropriate to treat this patient with acetaminophen if there were no contraindications, they required analgesia, and even if ibuprofen had been contraindicated.

Have a great day and thank you for being engaged in optimum patient safety.

Clinical Education Coordinator



References:

https://academic.oup.com/acn/article/24/1/3/3457?login=false

https://www.researchgate.net/publication/305711498_Traumatic_brain_injury_It_is_all_about_definition

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

Definitions of Traumatic Brain Injury - Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans - NCBI Bookshelf (nih.gov)

Traumatic brain injury - Brain Injury Canada

https://mediclearn.rppeo.ca/course/view.php?id=293

https://www.rppeo.ca/paramedic-practice/medical-direction/medicask/medicask-answers-all/253-medical-directives/adult-analgesia/1530-nsaids-in-high-mechanism-of-injury.html