Pre-hospital and initial management of head injury patients: An update

Abstract

Background:Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on “Prehospital Management” published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006.Methods:A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted.Results:Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided.Conclusion:Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

Sanguinate's effect on pial arterioles in healthy rats and cerebral oxygen tension after controlled cortical impact

“…Early intervention to alleviate decreased PbtO 2 following TBI is a critical step as the degree and duration of low PbtO 2 is related to neurological outcome (Brenner et al, 2012;Chi et al, 2006;Chowdhury et al, 2014). In animal studies of TBI, increasing the inspired oxygen concentration enhanced aerobic metabolism by increasing brain oxygen pressure (Menzel et al, 1999a;Menzel et al, 1999b).…”

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

“…2 Patients with TBI can have improved outcomes with prompt evaluation and early emergency management in the prehospital setting. 3 Management is challenging for these patients and requires resources often difficult to obtain in low-and middle-income countries (LMICs), like in Africa, leading to worse outcomes. 4 In Sub-Saharan Africa, there is a paucity of accurate data on the contribution of head injury to trauma-related mortality, especially in the prehospital setting.…”

Identification of clinical and radiological predictors of outcome in head trauma patients in the emergency department

“…In patients having SDH (25% of total), 40 patients (44.44%) had poor outcome. (19)(20)(21)(22)(23)(24) Moderate (11)(12)(13)(14)(15)(16)(17)(18) Severe ( In this study, the mean GCS score was 10.61 .110 patients had a GCS score 8 or less (31.42%). 80of those patients (72.72%) had GOS V score.…”