Initial management of traumatic brain injury in the rural setting

Stephen Honeybul; Paul Woods

doi:10.4103/0976-3147.105607

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Review Article

4 (

); 33-38

doi:

10.4103/0976-3147.105607

Initial management of traumatic brain injury in the rural setting

Stephen Honeybul^,, Paul Woods

Departments of Neurosurgery, Western Australia

1 Departments of Intensive Care Medicine, Sir Charles Gairdner Hospital and Royal Perth Hospital, Western Australia

Dr. Honeybul S Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital Western Australia stephen.honeybul@health.wa.gov.au

Journal of Neurosciences in Rural Practice

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This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

ABSTRACT

Healthcare workers in the rural setting face unique problems when dealing with head injured patients however the basic principle of medical management are the same in any situation. The key initial elements remain aggressive early resuscitation followed by a comprehensive assessment of conscious level and either early consultation or transfer to a neurosurgical facility. What has improved considerably over recent years is the understanding of the pathophysiology of traumatic brain injury and as such some of the medical management strategies have changed. A basic understanding of some of these concepts is useful in the clinical setting and serves to emphasis the importance of effective early medical management. Thereafter consideration must be given to which patients require radiological investigations and possible discussion with or transfer to a neurosurgical facility.

Keywords

Initial management

traumatic brain injury

rural trauma

Show Related Articles from PubMed

Conflicts of interest

None declared

REFERENCES

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[1] Sahuquillo J, Poca M. A., Amoros S, . Current aspects of pathophysiology and cell dysfunction after severe head injury. Curr Pharm Des. 2001;7:1475-503.
[Google Scholar]

[2] Reilly P. L., . Brain injury: The pathophysiology of the first hours ‘Talk and Die revisited’. J Clin Neurosci. 2001;8:398-403.
[Google Scholar]

[3] Nicholls D. G., Ward M. W., . Mitochondrial membrane potential and neuronal glutamate excitotoxicity: Mortality and millivolts. Trends Neurosci. 2000;23:166-74.
[Google Scholar]

[4] Manley G, Knudson M. M., Morabito D, Damron S, Erickson V, Pitts L, . Hypotension, hypoxia, and head injury: Frequency, duration, and consequences. Arch Surg. 2001;136:1118-23.
[Google Scholar]

[5] Ertmer C, Kampmeier T, Rehberg S, Lange M, . Fluid resuscitation in multiple trauma patients. Curr Opin Anaesthesiol. 2011;24:202-8.
[Google Scholar]

[6] Simma B, Burger R, Falk M, Sacher P, Fanconi S, . A prospective, randomized, and controlled study of fluid management in children with severe head injury: Lactated Ringer’s solution versus hypertonic saline. Crit Care Med. 1998;26:1265-70.
[Google Scholar]

[7] Teasdale G, Jennett B, . Assessment and prognosis of coma after head injury Acta Neurochir (Wien). 1976;34:45-55.

[8] Steyerberg E. W., Mushkudiani N, Perel P, Butcher I, Lu J, McHugh G. S., et al. . Predicting outcome after traumatic brain injury: Development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5:e165.
[Google Scholar]

[9] Curley G, Kavanagh B. P., Laffey J. G., . Hypocapnia and the injured brain: More harm than benefit. Crit Care Med. 2010;38:1348-59.
[Google Scholar]

[10] Heffner J. E., Sahn S. A., . Controlled hyperventilation in patients with intracranial hypertension. Application and management. Arch Intern Med. 1983;143:765-9.
[Google Scholar]

[11] Rea G. L., Rockswold G. L., . Barbiturate therapy in uncontrolled intracranial hypertension. Neurosurgery. 1983;12:401-4.
[Google Scholar]

[12] Sahuquillo J, Vilalta A, . Cooling the injured brain: How does moderate hypothermia influence the pathophysiology of traumatic brain injury. Curr Pharm Des. 2003;13:2310-22.
[Google Scholar]

[13] Eisenberg H. M., Frankowski R. F., Contant C. F., Marshall L. F., Walker M. D., . High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988;69:15-23.
[Google Scholar]

[14] Hutchison J. S., Ward R. E., Lacroix J, Hébert P. C., Barnes M. A., Bohn D. J., et al. . Hypothermia Pediatric Head Injury Trial Investigators and the Canadian Critical Care Trials Group. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;5:2447-56.
[Google Scholar]

[15] Clifton G. L., Valadka A, Zygun D, Coffey C. S., Drever P, Fourwinds S, et al. . Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): A randomised trial. Lancet Neurol. 2011;10:131-9.
[Google Scholar]

[16] Abdul Latip L. S., Ahmad Alias N. A., Ariff A. R., Shuaib I. L., Abdullah J, Naing N. N., . CT scan in minor head injury: A guide for rural doctors. Clin Neurosci. 2004;11:835-9.
[Google Scholar]

[17] Simpson D. A., Worth R. J., . Neurotrauma in country hospitals: The role of computerized tomography scanning. Aust N Z J Surg. 1989;59:1-3.
[Google Scholar]

[18] Ingebrigtsen T, Romner B, Kock-Jensen C, . Scandinavian guidelines for initial management of minimal, mild, and moderate head injuries. The Scandinavian Neurotrauma Committee. J Trauma. 2000;48:760-6.
[Google Scholar]

[19] Bratton S. L., Chestnut R. M., Ghajar J, McConnell-Hammond F. F., Harris O. A., Hartl R, et al. . Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24:S83-6.
[Google Scholar]

[20] Stiell I. G., Wells G. A., Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. . The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391-6.
[Google Scholar]

[21] Abdul-Latip L. S., Ahmad-Alias N. A., Ariff A. R., Shuaib I. L., Abdullah J, Naing N. N., . CT scan in minor head injury: A guide for rural doctors. J Clin Neurosci. 2004;11:835-9.
[Google Scholar]

[22] Easter J. S., Grossman S. A., Woodruff M. M., Rosen C. L., . When the rules do not work: Head injury without loss of consciousness. J Emerg Med. 2008;35:77-80.
[Google Scholar]

Initial management of traumatic brain injury in the rural setting

Abstract

ABSTRACT

Keywords

Initial management

traumatic brain injury

rural trauma

Conflicts of interest

REFERENCES

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