title: [Early management of severe brain injuries].
abstract: Severe head injury (Glasgow Coma Score less than or equal to 7) is associated with high mortality and morbidity which can be improved by early energetic therapy. Such patients must be picked up by prehospital/EMS service with three aims: controlling ventilation, controlling haemodynamics, avoiding any increased intracranial pressure. After initial neurological assessment, management involves endotracheal intubation, mechanical ventilation following benzodiazepine sedation, early compensation of hypovolemia avoiding any overloading, analgesia for painful injuries; according to the clinical status other pharmacological agents can be used. At admission to emergency unit, intensive care must be continued while X-rays and CT-scan are achieved. Imperative indications of transport to neuro-intensive care unit are discussed for hospitals without a neuro-surgeon.
authors.affiliation: Réanimation Chirurgicale et Traumatologique, Hôpital Général, Centre Hospitalier Régional et Universitaire, Dijon.
authors.forename: D
authors.initials: D
authors.lastname: Honnart
authors.forename: N
authors.initials: N
authors.lastname: Defrance
authors.forename: M T
authors.initials: MT
authors.lastname: Noirot
authors.forename: M
authors.initials: M
authors.lastname: Freysz
authors.forename: M
authors.initials: M
authors.lastname: Wilkening
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D004632:Emergency Medical Services; D005392:First Aid; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure; D007442:Intubation, Intratracheal; D011379:Prognosis; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed
vernacular_title: Prise en charge initiale d'un traumatisme cranien grave.