Army neurosurgeon LTC Ryan Morton, MD, joins us for a compelling discussion on the high-stakes environment of combat neurosurgery. We delve into the strategies crucial for managing head trauma on the battlefield, where preventing hypoxia and hypotension is paramount for saving lives. Dr. Morton shares invaluable insights on how military medical teams maintain vigilance against these conditions despite the lack of advanced imaging capabilities. From arterial blood pressure monitoring to oxygen therapy, we cover the proactive measures used to manage intracranial pressure effectively, ensuring that even in the toughest settings, soldiers receive the best possible care.     Our conversation evolves into a detailed exploration of the surgical techniques employed in trauma response. We discuss the significance of patient positioning, the careful balancing of resuscitation efforts, and the pivotal role of Roll 3 hospitals with their advanced CT scanning capabilities. The episode also shines a light on the logistical aspects of performing complex procedures like spine surgeries and managing traumatic vasospasm in military environments. Dr. Morton touches on the challenges of treating severe injuries in combat zones and the thoughtful considerations involved in using endovascular techniques for managing carotid injuries. Join us for an episode packed with expert insights and real-world solutions for the unique challenges faced in military medical care.   Chapters:   (00:02) Combat Neurosurgery (11:14) Surgical Techniques in Trauma Response (17:18) Combat Medical Care and Consultation   Chapter Summaries:   (00:02) Combat Neurosurgery   Managing head trauma in combat zones requires vigilance against hypoxia and hypotension, with measures such as blood pressure monitoring and oxygen therapy.   (11:14) Surgical Techniques in Trauma Response    Maintaining brain health in trauma management through proper positioning, blood coagulation, and advanced capabilities of Roll 3 hospitals.   (17:18) Combat Medical Care and Consultation    Logistics of spine fusions, protocols for head trauma, challenges of treating vasospasm, and endovascular techniques for carotid injuries.   Take Home Messages: Combat neurosurgery requires a proactive approach to managing head trauma on the battlefield, emphasizing the prevention of hypoxia and hypotension. Despite the lack of advanced imaging capabilities, military medical teams can effectively monitor and manage intracranial pressure through vigilant use of arterial blood pressure monitoring and oxygen therapy.   Patient positioning, such as using the reverse Trendelenburg position, plays a crucial role in reducing intracranial pressure in trauma cases. Maintaining proper blood coagulation and sodium levels is essential to avoid complications, and the advanced capabilities of Roll 3 hospitals, like CT scanning, are vital for determining the appropriate neurosurgical interventions.   While immediate spine surgeries may be necessary in combat zones, complex procedures are often preferred to be performed in more sterile environments such as Landstuhl, Walter Reed, or BAMC. These facilities provide the necessary resources and expertise to manage severe injuries and offer comprehensive care.   The use of seizure prophylaxis, such as Keppra or Dilantin, should be carefully considered in cases of suspected head trauma. However, it is typically not an immediate priority unless the patient is actively seizing. If a severe traumatic brain injury is confirmed, seizure prophylaxis may be beneficial for a limited period.   Endovascular techniques for managing carotid injuries, such as deploying covered stents or performing balloon test occlusions, require careful consideration and are best performed in well-equipped facilities away from the battlefield. The treatment of traumatic vasospasm, which can occur days after the initial trauma, should be managed in specialized centers to ensure optimal patient