Traumatic Brain Injury in Adults
Traumatic Brain Injury in Adults
Management at the scene and in the emergency department should follow the principles of prehospital and advanced trauma life support courses (ie, assessment and treatment of the most urgent problems first in a systematic order; figure 2). Patients who are comatose or who have deteriorating consciousness should have their airway secured (if necessary with intubation), adequate oxygenation and ventilation, and fluid replacement to avoid hypotension. Spinal immobilisation should be maintained until clinical assessment and/or imaging studies indicate that it can be removed. In the emergency department, a primary survey and simultaneous resuscitation need to be undertaken for all head-injured patients, including those with mild TBI. Clinicians should also focus on TBI signs and symptoms (figure 2).
(Enlarge Image)
Figure 2.
Initial management of traumatic brain injury (TBI). In addition to the above, patients with a deteriorating Glasgow Coma Scale score (GCS) (particularly deteriorating motor component), progressive neurological signs, penetrating injuries and cerebrospinal fluid (CSF) leak should also be discussed with the local neurosurgical unit (NSU). National Institute for Health and Clinical Excellence (NICE) guidance regarding the selection of adults for CT scanning of the head can be accessed online at http://www.nice.org.uk/nicemedia/live/11836/36257/36257.pdf. ICU, intensive care unit.
What Is the Initial Management of TBI?
Management at the scene and in the emergency department should follow the principles of prehospital and advanced trauma life support courses (ie, assessment and treatment of the most urgent problems first in a systematic order; figure 2). Patients who are comatose or who have deteriorating consciousness should have their airway secured (if necessary with intubation), adequate oxygenation and ventilation, and fluid replacement to avoid hypotension. Spinal immobilisation should be maintained until clinical assessment and/or imaging studies indicate that it can be removed. In the emergency department, a primary survey and simultaneous resuscitation need to be undertaken for all head-injured patients, including those with mild TBI. Clinicians should also focus on TBI signs and symptoms (figure 2).
(Enlarge Image)
Figure 2.
Initial management of traumatic brain injury (TBI). In addition to the above, patients with a deteriorating Glasgow Coma Scale score (GCS) (particularly deteriorating motor component), progressive neurological signs, penetrating injuries and cerebrospinal fluid (CSF) leak should also be discussed with the local neurosurgical unit (NSU). National Institute for Health and Clinical Excellence (NICE) guidance regarding the selection of adults for CT scanning of the head can be accessed online at http://www.nice.org.uk/nicemedia/live/11836/36257/36257.pdf. ICU, intensive care unit.
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