Traumatic brain injury medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Joanna Ekabua, M.D. [2] Deekshitha Manney, M.D.[[3]]
Overview
Traumatic brain injury (TBI) is a medical emergency and requires prompt treatment. The treatment is based on the type of TBI. But the primary focus of the treatment for all types is to prevent cerebral edema and to maintain intracranial pressure (ICP) within normal limits. [1]
Medical Therapy
- Traumatic brain injury is a medical emergency and requires prompt treatment.[2]
- Hyperventilation
- Seizure prophylaxis
- Hyperosmolar therapy
- Medically induced coma
- Therapeutic hypothermia
- ICP Monitoring
- Medical care usually begins when paramedics or emergency medical technicians arrive on the scene of an accident or when a TBI patient arrives at the emergency department of a hospital. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize the patient and focus on preventing further injury. Primary concerns include insuring proper oxygen supply, maintaining adequate blood flow, and controlling blood pressure. Since many head-injured patients may also have spinal cord injuries, the patient is placed on a back-board and in a neck restraint to prevent further injury to the head and spinal cord. Medical personnel assess the patient's condition by measuring vital signs and reflexes and by performing a neurological examination. They assess the patient's level of consciousness and neurological functioning using the Glasgow Coma Scale.
- Barbiturates can be used to decrease ICP; mannitol was thought to be useful, but it appears likely that the studies suggesting that it was of use[3][4][5] may have been falsified.[6]
Contraindicated medications
Recent intracranial trauma is considered an absolute contraindication to the use of the following medications:
[[Category:Needs review]]
References
- ↑ Smith TR. Neurosurgery. In: Doherty GM. eds. Current Diagnosis & Treatment: Surgery, 15e. McGraw-Hill; Accessed April 25, 2021. https://accessmedicine.mhmedical.com/content.aspx?bookid=2859§ionid=242161973
- ↑ Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhao LR (2017). "Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors". Cell Transplant. 26 (7): 1118–1130. doi:10.1177/0963689717714102. PMC 5657730. PMID 28933211.
- ↑ Cruz J, Minoja G, Okuchi K. (2001) Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery. Volume 49, Issue 4, Pages 864-871. PMID 11564247
- ↑ Cruz J, Minoja G, Okuchi K. (2002) Major clinical and physiological benefits of early high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial. Neurosurgery. Volume 51, Issue 3, Pages 628-637; discussion 637-638. PMID 12188940
- ↑ Cruz J, Minoja G, Okuchi K, Facco E. (2004) Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. Journal of Neurosurgery. Volume 100, Issue 3, Pages 376-383. PMID 15035271
- ↑ Roberts I, Smith R, Evans S. (2007) Doubts over head injury studies. BMJ. Volume 334, Issue 7590, Pages 392-394. PMID 17322250