Which is better for the brain injured patient, mannitol or hypertonic saline?
As the treatment of malignancy evolves, the number patients who are receiving active chemotherapy presenting to the Emergency Department is increasing. Many of these patients present with respiratory chief complaints ranging from mild dyspnea to acute respiratory distress. This post aims to introduce chemotherapy-induced pulmonary toxicity and review those chemotherapuetic agents that commonly affect the lungs.
Following a severe brain injury the goal of the clinician is to prevent secondary brain injury. This entails increasing oxygen delivery to the brain by preventing hypoxia and increasing cerebral perfusion. Hyperosmolar therapy, including mannitol and hypertonic saline, is often used to decrease ICP.
When patients present to the Emergency Department with acute upper GI bleeding, the natural inclination is to quickly pull the transfusion trigger. However, a 2013 study gives us pause: