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Review
. 2017 Oct;97(5):1015-1030.
doi: 10.1016/j.suc.2017.06.003.

Acute Management of Traumatic Brain Injury

Michael A Vella  1 , Marie L Crandall  2 , Mayur B Patel  3
Affiliations
Review

Acute Management of Traumatic Brain Injury

Michael A Vella et al. Surg Clin North Am. 2017 Oct.

Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization.

Keywords: Barbiturate coma; Decompressive craniectomy; Hyperosmolar therapy; Intracranial hypertension; Secondary injury; Traumatic brain injury.

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Figures

Figure 1
Figure 1
Algorithmic Approach to the Management of Severe Traumatic Brain Injury (GCS <9) Simple algorithm for the management of severe head injury as described in the text. CBC=complete blood count; BMP=basic metabolic panel; PT/INR=prothrombin time/international normalized ratio; PTT=partial thromboplastin time; ABG=arterial blood gas; Osm=osmolality; HOB=head of bed; SBP=systolic blood pressure; IPC=intraparenchymal contusion; EDH=epidural hematoma; SDH=subdural hematoma; FFP=fresh frozen plasma; DHT=Dobhoff tube; ICP=intracranial pressure; TICU=trauma ICU; NSU=neurosurgery; CPP=cerebral perfusion pressure; EVD=extraventricular drain; CSF=cerebrospinalfluid; CVP=central venous pressure; NaCl=sodium chloride; Na=sodium; EEG=electroencephalogram
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References

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    1. CDC Website
    1. Crandall
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MeSH terms