Current level of prehospital care in severe head injury--potential for improvement.
The fact that 50-60% of cases with severe head injury result from traffic accidents underlines the great significance of emergency care and of its organization. Many patients with severe head injury are threatened from vital complications diagnosed with delay, or not at all, which plays a major role not only for survival but also for the quality of recovery and regaining of employment capabilities. Thus, the necessity of qualified and trained physicians with experience in emergency care is obvious. Emergency care can be divided into an early resuscitation phase of securing or reestablishment of general vital functions, and a following stabilisation phase with administration of measures directed towards the specific conditions underlying trauma. 1. Prevention and treatment of respiratory complications. In addition to classical emergency care measures, endotracheal suction might be employed. The most effective method for clearance of airways and, thus, securing of the cerebral oxygenation is endotracheal intubation. Early intubation provides also for control of the intracranial pressure by hyperventilation and administration of O2. Recently assistant ventilation is available as compared to the past when only controlled ventilation was possible. 2. Circulatory support. A major requirement for a sufficient cerebral perfusion is an adequate cerebral perfusion pressure making necessary early fluid substitution. In case the patient is in circulatory shock, shock-specific treatment may compete with adequate positioning of the patient. 3. Pharmacological treatment in the prehospital phase. Although dexamethasone has been reported to directly influence brain edema, its benefits in head injury are not clear. Currently conducted clinical studies using markedly higher doses may provide so far missing information.(ABSTRACT TRUNCATED AT 250 WORDS)
Sefrin
P
P
Institute of Anaesthesiology, University of Würzburg, Federal Republic of Germany.
D001925:Brain Damage, Chronic / Q000401:mortality / Q000628:therapy*; D004630:Emergencies; D005392:First Aid; D016489:Head Injuries, Closed / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate