Prehospital management of severe traumatic brain injury

Traumatic Brain Injury (TBI) is a leading cause of death worldwide. This patient cohort presents a myriad of challenges to the prehospital clinician. In Australia road traffic injuries are a major cause of death and over 60% of fatalities are due to head injury (ABS, 2003).

Guidelines for Prehospital Management of Traumatic Brain Injury is a work published by a group of clinical experts in prehospital and emergency trauma care, most recently revised in 2008 (Badjatia et al, 2008). Their evidence-based recommendations are the result of an initiative of the Brain Trauma Foundation to assist prehospital care providers in their assessment and management of TBI. This paper integrates these recommendations of practice in a practical approach to managing severe traumatic brain injury patients.

PATHOPHYSIOLOGY Primary and secondary brain injury:

The pathophysiology of TBI is divided into two components: primary brain injury and secondary brain injury. Primary brain injury occurs at the moment of trauma, it is irreversible and determined by the force and mechanism of injury. It results in a combination of intracranial hematomas, contusions and sheering between white and grey matter (diffuse axonal injury). Secondary brain injury occurs from the time of the initial injury and up to days following. It is caused by the progressive development of ischemia from traumatised intracranial structures, molecular inflammatory responses and cerebral edema that leads to cell (Wilkins and Rengachary, 1996).