Prehospital management of traumatic brain injury

Abstract

<jats:p>The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.</jats:p>

The prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review

“…An observational study from the Western Cape did, however, identify an increased mortality in TBI patients who underwent prehospital intubation. [19] Other factors that have been associated with an increase in mortality (injury severity, BP, hypoand hypercapnia, and hypoxaemia) [1,[3][4][5][6][7][8][9][10][11][12] in this population were not reported on. There was no statistical difference in the prevalence of hypoxaemia in patients who were intubated in the field v. those who were not (p=0.15).…”

“…[6] Cerebral tissue is particularly vulnerable to these secondary insults in the period immediately following a TBI. [10][11] A case can be made for earlier intervention to avoid these insults, indicating the importance of prehospital care in TBI. These findings were corroborated in an Australian study that described an additive dose relationship between hypotension and mortality, i.e.…”

“…[8] Most TBIs are followed by an epsiode of apnoea, even if just for a brief period. [10] Numerous studies have revealed the impact that hypoxaemia (partial pressure of oxygen (PaO 2 ) <60 mmHg or oxygen saturation (SpO 2 ) <90%) has on the eventual outcome of patients who have sustained a TBI. Chesnut et al [4] in their large prospective study found the admission prevalence of hypoxaemia in moderate to severe TBI to be 22.4%.…”

Perbandingan Efektivitas Natrium Laktat dengan Manitol untuk Menurunkan Tekanan Intrakranial Penderita Cedera Kepala Berat

“…12,13 Pemberian larutan garam hipertonik pada hewan percobaan yang mengalami syok hemoragik mampu menurunkan tekanan intrakranial serta edema serebri, juga meningkatkan aliran darah otak dan pengantaran oksigen. 3 Selain itu, beberapa penelitian klinis memperlihatkan larutan garam hipertonik mampu menurunkan tekanan intrakranial penderita cedera kepala dan mempersingkat masa rawat di Intensive Care Unit (ICU).…”

Insight on Secondary Brain Injuries from Paramedic Treatment that are 4-Times Likely to Occur Prior to Pre-Hospital Treatment and ER Submissions

“…The most common cause is falls, which have become increasingly common as a source of severe traumatic brain injury [1]. According to a Canadian report, falls account for approximately 40% of both overall trauma and injuryrelated deaths.…”