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Seminars in Neurosurgery 2003; 14(2): 071-078
DOI: 10.1055/s-2003-42760
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Pre-Hospital Treatment of Traumatic Brain Injury

John H. Chi, Venu Nemani, Geoffrey T. Manley
  • Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Publication History

Publication Date:
02 October 2003 (online)

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ABSTRACT

Pre-hospital management of traumatic brain injury (TBI) clearly influences the morbidity and mortality outcomes in patients with TBI. Recent clinical and laboratory evidence suggests that secondary brain injuries can be lessened with appropriate and expeditious interventions performed in the pre-hospital arena. Hypotension, even a single episode of systolic blood pressure < 90 mm Hg, and hypoxia have powerful negative effects on outcome. The recognition and treatment of these conditions can be fairly simple and uncomplicated, including fluid boluses with isotonic or hypertonic saline and field intubation. Other pre-hospital interventions, such as hyperventilation and steroid doses, have proved to be harmful or ineffective in the overall management of TBI. However, conflicting opinion and unclear evidence only demonstrate the need for better class I evidence in pre-hospital management of head trauma.

KEYWORDS

Hypotension - hypoxia - pre-hospital management - traumatic brain injury

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