Can I check with folks and see what your "standard of care" is for mannitol
in traumatic brain injury? I have been running my EM residents through a
sim case of a 6 mo shaken baby and one of them was VERY emphatic that the
Cochrane review showed increased mortality and/or no effect if mannitol is
used ( I know that the evidence is terrible for it's uses but this was the
first time I had heard that). I red the summary and am pretty sure that
the Cochrane review doesn't say this...but just wanted to see if I am way
off the mark!
Second question: who is routinely using hypertonic saline instead of
Mannitol? It was interesting to note that in one of the randomized studies
showed higher mortality with Mannitol vs hypertonic saline....thoughts?
Mike Falk, MD
St Luke's/Roosevelt Hospital
New York, NY.
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