Management and monitoring of the pre hospital

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Management and monitoring of the pre hospital

Open in a separate window The technique and equipment are also equally important to manage the pre-hospital intubations, especially by the paramedics. In this regard, the role of video-laryngoscopes and other difficult intubation kits may certainly give better chances for airway management and thus would prevent the secondary brain injuries related to hypoxemia.

Similarly, a retrospective review of patients on targeted ventilation PaCO2 mmHg at the emergency department also found decreased mortality However, in cases with signs of potential brain herniation, transient hyperventilation may be an option. There is strong evidence that capnography can affect the outcome.

Therefore, continuous capnography is recommended in all ventilated TBI patients. Oxygenation and ventilation can become difficult if there are other major injuries, particularly chest injuries, aspiration of gastric contents or acute pulmonary edema.

Appropriate positive end expiratory pressure PEEP should be used. However, recent studies have challenged the lower limit to define hypotension in patients with isolated head injury. It is recommended that patients with severe TBI have arterial and central venous lines placed as soon as practical.

Hypertension may be a physiological response produced due to sympathetic surge, and may signify a compromised cerebral perfusion. For the treatment of hypertension to achieve CPP targets, an infusion of short-acting beta blocker is very useful, which maintains blood pressure.

These agents do not cause cerebral vasodilatation when compared with nitrates and calcium channel blockers and, therefore, do not increase the cerebral blood volume and ICP. However, the choice of fluids is still a matter of great conflict. Some studies have suggested that hypertonic fluids might suppress the biomarkers of TBI and are correlated with better outcome.

No studies have reported better survival and functional outcomes over the use of isotonic crystalloids. The role of colloids in mild to moderate severe head injury is at present inconclusive and therefore needs well-designed RCTs.

PH Hypothermia has some protective effects in TBI by reducing ICP, cerebral metabolic demands, decreasing disruption of the blood—brain barrier and inhibiting the inflammatory cascade. Induced hypothermia is now an accepted measure to improve outcome following anoxic brain injury associated with cardiac arrest, but its benefits in TBI are inconclusive at present.

On the other hand, in an epidemiological study level III evidence of 21, patients, PH was found to be independently associated with increased adverse events, including need for a transfusion, mortality, incidence of adult respiratory distress syndrome and pneumonia.

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Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management.

Isotonic saline should be used as the first choice for fluid resuscitation.

Management and monitoring of the pre hospital

The PH has more adverse effects and should therefore be avoided. Table 5 Open in a separate window Most of the management trials published after have focused mainly on the treatment as well as the prevention strategies for secondary brain injury.

The results of these trials would certainly be adopted by new standardized guidelines and, therefore, may have a substantial impact on the pre-hospital management in patients with TBI. Footnotes Conflict of Interest: The impact of traumatic brain injuries: Epidemiology and month outcomes from traumatic brain injury in australia and new zealand.

Epidemiology of traumatic brain injury in eastern China, A prospective large case study.

Caterino JM, Raubenolt A. The prehospital simplified motor score is as accurate as the prehospital Glasgow coma scale: Analysis of a statewide trauma registry.Only Hospital in Indore having Full Time Doctors available for patients round the clock.

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