title: [Acute treatment of patients with severe traumatic brain injury].
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a leading cause of death and permanent disability and a common and important global problem. The contribution of secondary posttraumatic brain damage to overall disability in TBI is significant, underlining the importance of prompt and comprehensive treatment for affected patients.
  
  
  METHODS
  This article focuses on current concepts of prehospital and emergency room management of patients with severe TBI to prevent secondary brain injuries.
  
  
  CONCLUSIONS
  Preclinical prevention and treatment of hypoxia, hypotension and hypercarbia are essential, as they affect the long-term outcome in TBI patients. Prehospital intubation should be critically weighed and in the context of an individual decision. In general, prehospital intubation is more difficult than in the clinical setting. The combination of ketamine and benzodiazepines are commonly used to induce anesthesia before intubation in hemodynamic instable patients. The choice of a muscle relaxant for anesthesia induction is either a non-depolarizing neuromuscular blocking agent or succinylcholine. Administration of mannitol or hypertonic saline is effective to rapidly decrease intracranial pressure. Whenever possible the final destination for transport of TBI patients should be a level I center with round the clock neurosurgical expertise. Trauma-induced coagulopathy should be recognized and immediately treated using a point-of-care testing.
  
  
  CONCLUSIONS
  Hypoxia, hypotension and hypercarbia should strictly be avoided to improve survival and neurological outcome in patients with severe TBI. The prehospital decision to intubate must be made on a case by case basis at the accident site. A level I trauma center should be the destination for this patient group.
authors.affiliation: Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland, Tareq.Juratli@uniklinikum-dresden.de.
authors.forename: T A
authors.initials: TA
authors.lastname: Juratli
authors.forename: S E
authors.initials: SE
authors.lastname: Stephan
authors.forename: A E
authors.initials: AE
authors.lastname: Stephan
authors.forename: S B
authors.initials: SB
authors.lastname: Sobottka
mesh_terms: D000758:Anesthesia; D001925:Brain Damage, Chronic / Q000209:etiology / Q000628:therapy; D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D002534:Hypoxia, Brain / Q000209:etiology / Q000517:prevention & control; D008991:Monitoring, Physiologic; D014193:Trauma Centers