Management of Head Injury in the Emergency Department

Despite aggressive management, severe emotional and physical disability or death occurs in the majority of patients with severe head injury. Significant recovery of function of impaired neuronal cells is possible if patients are rapidly and effectively resuscitated after focal or diffuse brain insults. However, if secondary insults such as hypotension, hypoxia, or intracranial hypertension occur, many vulnerable cells may be irreversibly damaged by a cerebral ischemia. The most important points in the management of traumatic brain insults are the maintenance of an adequate cerebral perfusion pressure rather than the control of intracranial hypertension as a means of averting cerebral ischemia, and recognition that aggressive hyperventilation to control increased cerebral pressure may aggravate cerebral ischemia. So it is recommended that cerebral perfusion pressure be maintained at or above 70mmHg and that use of prophylactic hyperventilation (PaCO2 < 35mmHg) should be avoided within the 1st 24 hours after brain injury.