TY - CHAP M1 - Book, Section TI - Head Injury A1 - Oropello, John M. A1 - Mistry, Nirav A1 - Ullman, Jamie S. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. Y1 - 2015 N1 - T2 - Principles of Critical Care, 4e AB - Primary injury occurs at the moment of trauma and is the result of direct damage to brain tissue. All subsequent preventable brain injuries are termed secondary injuries.Head trauma is associated with cervical spine injury and stabilization of the spine (eg, cervical collar, log rolling) is maintained until the spine is cleared.Hypoxemia, hypotension, and raised intracranial pressure (ICP) are the leading causes of death in severe traumatic brain injury (TBI) and are related to the severity of the brain injury as well as the systemic complications.Critical care of the TBI patient is centered on airway control, favoring early intubation, resuscitation, maintenance of homeostasis, early detection of neurosurgically treated complications, and interpretation of information from bedside monitors to minimize disruption of cerebral perfusion, (oxygenation and nutrient supply) in order to prevent or limit secondary injury.Level II evidence supports a minimum systolic blood pressure of 90 mm Hg. An SBP of 70 mm Hg has been associated with the development of acute respiratory distress syndrome (ARDS).TBI is the second highest risk factor for the development of venous thromboembolism (VTE), second only to acute spinal cord injury and the incidence of deep venous thrombosis (DVT) 7 to 10 days after TBI is as high as 31.6% even with mechanical prophylaxis.Antiseizure prophylaxis with phenytoin is recommended for the prevention of early posttraumatic seizures, that is, within 7 days of the TBI. Routine prophylaxis later than 1 week following TBI is not recommendedRecent studies have not demonstrated an overall beneficial effect of steroids on outcome and there is level I evidence that high-dose methylprednisolone increases mortality after moderate to severe TBI.After TBI, persistent ICP >20 is associated with poor outcome and there are limited data—class III and II level evidence—that patients responding to ICP lowering treatments have a lower mortality and better outcome. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1107713103 ER -