What two medications can worsen a moderate to severe TBI but are acceptable for mild TBI?

Fentanyl and Ketamine can be used in mild traumatic brain injury (TBI) settings due to their analgesic properties, providing effective pain management without significantly affecting intracranial pressure or cerebral blood flow. In the context of a moderate to severe TBI, however, these medications should be used with caution. Fentanyl, being an opioid, has the potential to depress respiratory function, which might lead to elevated carbon dioxide levels, potentially worsening brain injury. Ketamine, while an anesthetic and pain-reliever, may cause dissociative effects that can complicate the neurological assessment of a patient with moderate to severe TBI.

In contrast, other options either do not align with the medical guidelines for TBI management or have specific side effects that can negatively impact patients with more severe injuries, such as increased bleeding risk with certain analgesics. Thus, the nuanced applications of Fentanyl and Ketamine reflect their relative safety in mild cases compared to their risks in severe situations.