[Management of severe traumatic brain injury].
Severe brain injuries, most often occurring in young subjects, are a major source of lost work years. These injuries are medical and surgical emergencies. Prehospital management of severe brain injuries requires intubation and mechanical ventilation aimed at normal arterial carbon dioxide pressure. Signs of transtentorial herniation: Uni- or bilateral mydriasis requires immediate perfusion of 20% mannitol or hypertonic sodium chloride. Neurological disorders after head injury justify emergency cerebral computed tomography. The presence of a mass syndrome or signs of transtentorial herniation are in principle indications for surgery. Specialized hospital management is essential. In the case of refractory intracranial hypertension, the cerebral perfusion pressure and osmotherapy should be adapted to the volume of the cerebral contusion. The use of deep hypothermia and barbiturates should be minimized as much as possible. Magnetic resonance imaging makes it possible to identify the cerebral lesions.
Lescot
Thomas
T
Département d'anesthésie-réanimation et Service de neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, Paris.
Abdennour
Lamine
L
Degos
Vincent
V
Boch
Anne-Laure
AL
Puybasset
Louis
L
D000740:Anemia / Q000209:etiology / Q000517:prevention & control; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000517:prevention & control; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D016292:Procedural Sedation; D003422:Critical Care / Q000379:methods*; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods; D004638:Emergency Treatment / Q000379:methods*; D004677:Encephalocele / Q000209:etiology / Q000517:prevention & control; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D006706:Homeostasis; D006801:Humans; D007036:Hypothermia, Induced; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial