[Protocol for advanced prehospital emergency care of severe head injury].
OBJECTIVE
To analyze the frequency of systemic factors leading to secondary brain insults in victims of serious head trauma in a prehospital setting and to evaluate a protocol for the advanced prehospital emergency care by mobile intensive care unit (i.e., the French Samu-Smur system).


METHODS
Prospective study, over a period of 24 months.


METHODS
This prospective study involved 60 victims of severe head injuries (with the exception of polytrauma patients). Tracheal intubation was performed on each patient under direct laryngoscopy and after induction of anaesthesia (fentanyl-etomidate-rocuronium). Controlled ventilation and vascular loading (objectives: SpO(2) >or= 97%, PETCO(2) between 30 and 35 mmHg, SAP >or= 90 mmHg) were administered.


RESULTS
Hypoxaemia was found to be the most frequent cause of secondary insults (57% of patients with SpO(2) < 97%). In the case involving an accident that occurred 17 km from the hospital (with extremes of 6-65 km), the speed of medical intervention was note-worthy: tracheal intubation was performed 50 min after the accident, and the patient was admitted into a trauma centre 101 min after impact (median). However, faster intervention could be obtained if the transmission of the alert was improved. The conditions under which the tracheal intubation was performed were found to be satisfactory (difficult intubation 1.6%) without deteriorating the haemodynamic status. This is probably related to the use of muscle relaxants and the choice of etomidate as the first line hypnotic in the prehospital emergency care.
Tentillier
E
E
Département des urgences, Samu 33, Smur, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux cedex, France. eric.tentillier@chu-bordeaux.fr
Dupont
M
M
Thicoïpé
M
M
Petitjean
M E
ME
Sztark
F
F
Lassié
P
P
Masson
F
F
Dabadie
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000628:therapy*; D004632:Emergency Medical Services; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies