New Modes in Management of Acut Traumatic Head Injury

Abstract

Traumatic brain injury (TBI) is a major cause of disability and death in humans . In the last 2 decades, the management ofTBI has evolved dramatically, as a result of a more thorough understanding of the physiologic events leading to secondary neuronal injury as well as advances in the care of critically ill patients. One central concept is now settled; All neurological damage does not occur at the moment of impact (primary injury), but rather evolves over the ensuing minutes, hours, and days. This secondary brain injury can result in increased mortality and more disabling injuries. The first priority in any injured patient is to stabilize the cervical spine, establish an adequate airway (A, airway), ensure adequate ventilation (B, breathing), and gain venous access to initiate volume resuscitation (C, circulation).These steps are cru­ cial in the head­injured patient to avoid both hypoxia and hypotension, the most important causes of secondary brain insults. The primary assessment should conclude with a determination of the level of consciousness and an examination of the pupils (D, disability).