Traumatic brain injury remains a major cause of morbidity and mortality particularly in young people and still has no specific treatment. The pathology of head injury is increasingly well understood. Mechanical forces result in shearing and compression of neuronal and vascular tissue at the moment of impact. A series of pathology events may then lead to further brain injury. This secondary injury may be amenable to intervention and is worsened by secondary physiological insults. Various risk factors for poor outcome after TBI have been identified. Most of these are fixed at the time of injury such as age, gender, mechanism of injury and presenting signs, but some as hypotension and hypoxia are potential areas for medical intervention.
Modern neurocritical care management utilizes a host of monitoring techniques to identify or predict the occurrence of secondary insults and guide subsequent therapeutic interventions in an attempt to minimize the resulting secondary injury. Recent data suggest that the use of protocolized management strategies, informed by multimodality monitoring, can improve patient outcome after traumatic brain injury.
The goals of prehospital management is to minimize or prevent secondary insult by maintaining brain oxygenation, blood pressure, cerebral perfusion pressure, and intracranial pressure.
Hospital management include intraoperative and ICU management. They aim at Maintaining adequate CPP, normocapnia, mild to moderate hypothermia, normalization of blood glucose, Hct. and pH and management of brain oedema, increased ICP by hyperosmolar solution, and the optimal use of anaesthetic.
TBI is the leading cause of death in childhood. Head trauma is more likely in young children than in adult due to their large and heavy heads and weak cervical ligaments and muscles. Resulting brain injury is more severe due to their thin, pliable skulls and the yet unfused sutures. |
