MANAGEMENT OF GUNSHOT HEAD INJURIES

Abstract

Many penetrating head injuries are incompatible with life, and people with these injuries often die almost immediately. Moderately injured patients more frequently are resuscitated and receive treatment. Upon presentation, beginning aggressive medical and surgical treatment is important in patients who may benefit from these interventions. Aggressive treatment of secondary mechanisms of injury must be initiated, and the patient must be monitored closely for possible complications.

There is considerable variability exists among neurosurgeons currently as to what constitutes appropriate treatment of PBI.In particular, wide variations exist in the amount of surgical debridement performed, the use of ICP monitoring, and the use of various medical therapies. Duration of anti-epileptics and antibiotics remains controversial, as does the use of hyperventilation, hypothermia, and steroids. Use of jugular bulb catheters and transcranial Doppler is institution-dependent.

Considerable research continues in the area of neurotrauma. Once secondary mechanisms of injury are better understood and treatment modalities are studied in prospective randomized clinical trials, less variation in management of PBI is likely to occur. The medical community as a whole will become more successful in the treatment of these patients.

Aggressive intensive care management in combination with surgical intervention, when appropriate, already has significantly reduced the mortality and morbidity associated with these injuries. Primary prevention of these injuries remains important. With the increasing numbers of firearms and firearm-related violence, discussing the issues of violence with patients and offering appropriate intervention becomes the duty of all health care providers.