Operational Anaesthesia for the Management of Traumatic Brain Injury

Abstract

The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the headinjured patient the best chance of recovery.

Military Anaesthesia in contingencies: what skill sets are required and how will we prepare our trainees?

“…Critical care: The Deployed Critical Care Guidelines for Operations (Hutchings S, currently unpublished) are discussed and there is a focus on the management of blast lung injury37 and traumatic brain injury 38. Depending on the contingency unit, there is always the possibility for a 48-hour holding period for any casualty, particularly in the maritime environment39 and so this section serves as a good revision for those who do not regularly have critical care in their job plan.…”