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Prehospital Care Crucial in Brain Injury Outcome

Authors provide overview of issues involved in traumatic brain injury care in field, including hypoxia, hypotension

MONDAY, Oct. 20 (HealthDay News) -- Minimizing secondary injuries and preventing secondary insults following traumatic brain injury (TBI) are crucial goals for emergency responders treating these traumas, according to research published in the October issue of Neurosurgical Focus.

Shirley I. Stiver, M.D., Ph.D., and Geoffrey T. Manley, M.D., Ph.D., of the University of California San Francisco, reviewed literature from 1980 to 2008 to assess prehospital management factors related to the outcome of TBI. Secondary insults are common in these situations and predict a poor outcome in these patients.

Airway management and hypoxia prevention is a priority, and patients should receive supplemental oxygen to maintain saturations above 90 percent, the authors write. In addition, hypotension is a concern since it may be more strongly related to poor outcome than hypoxia, they note. Another concern is elevated intracranial pressure, which must be urgently treated if the patient shows signs of cerebral herniation; this can be accomplished with acute hyperventilation and administration of mannitol, the report indicates.

"The goals of prehospital care for TBI are to stabilize patients for transport, to triage those with mass lesions and impending cerebral herniation, and to prevent secondary insults and injury. Organized trauma systems with defined protocols for field resuscitation, modes of transport and trauma facility destination ensure reproducible high-quality prehospital care. Given the proximity to the time of impact, advances in prehospital practice are a key target for further improvements in long-term functional outcomes following TBI," the authors conclude.

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