Prehospital management of severe traumatic brain injury

doi:10.1136/bmj.b1683

Published 19 May 2009, doi:10.1136/bmj.b1683
Cite this as: BMJ 2009;338:b1683

Clinical Review

Prehospital management of severe traumatic brain injury

Clare L Hammell, specialist registrar anaesthesia and intensive care medicine¹^,3, J D Henning, consultant anaesthesia and intensive care²^,3

¹ Royal Liverpool University Hospital, Liverpool L7 8XP, ² James Cook University Hospital, Middlesbrough TS4 3BW, ³ Great North Air Ambulance Service, Darlington DL1 5NQ

Correspondence to: C Hammell cham37uk@yahoo.com

The first 150 words of the full text of this article appear below.

Management of severe traumatic brain injuryis focused on rapid transfer to secondary care while preventingsecondary brain injury

Airway compromise and inadequate ventilationare common and should be addressed immediately

Prehospitalendotracheal intubation should be undertaken with the assistanceof anaesthetic drugs by appropriately trained physicians

Hypotensionis an independent risk factor for mortality; small boluses ofisotonic crystalloid fluids should be given if it occurs

Patientsmay be best managed in a neurosurgical centre where they shouldreceive definitive neurosurgical treatment within 4 hours ofinjury

There is no role for the routine use of corticosteroidsin patients with head injury

We searched Medline 1980-2008,Pubmed and the Cochrane library for clinical trials and reviews.The medical subject headings "head injury", "brain injury","trauma", "prehospital", and combinations thereof were used.Individual therapeutic options (such as "mannitol") were alsosearched for. Search results were individually reviewed andmanually cross . . . [Full text of this article]

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Rapid Responses:

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Mannitol: does it accelerate depletion of intracerebral adenine nucleotide pools?: Richard G Fiddian-Green
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