KEY POINTS
Neurotrauma is the leading cause of trauma-related death in patients ages 1 to 45 years. It
is categorized by mechanism, imaging findings, and anatomic involvement.
Cerebral blood flow requires adequate cerebral perfusion pressure, defined by mean arterial pressure minus intracranial pressure.
Initial management requires assessing neurologic status, maintaining adequate mean
arterial pressure, treating elevated intracranial pressure (ICP), avoiding secondary injury,
and obtaining emergent neuroimaging.
Airway considerations such as preoxygenation, head of bed elevation, first pass success,
and postintubation analgesia and sedation are essential in avoiding further worsening of
traumatic insults including hypotension and hypoxemia.
Neurosurgical consultation is required for optimal management, and the use of neurocritical care teams can improve patient outcome.
ARTIGO DE REVISÃO COM IMPORTANTE IMPACTO NA PRÁTICA CLINICA, RESPONDENDO QUESTÕES TERAPÊUTICAS, NEUROPROTEÇÃO E NEUROMONITORIZAÇÃO.
WHAT ARE SECONDARY INJURIES, AND ARE THEY DANGEROUS?
ResponderExcluirNeurotrauma begins a cascade of inflammatory cytokines that worsens ischemia and edema, resulting in secondary injury and poor patient outcomes. The following elements are believed to be linked to the development of secondary injury and provide rational targets for neuroresuscitation in the ED:
-Hypotension: Present in 30% of patients, resulting in higher likelihood of poor outcome (odds ratio, 2.67).
-Hypoxia: Present in 50% of patients, resulting in a higher likelihood of poor outcome (odds ratio, 2.14).
-Hyperoxia: PaO2 levels of greater than 300 to 470 mm Hg are associated with worse outcomes.
-Hyperpyrexia: Elevated core body temperature worsens morbidity by secondary brain injury aggravation.
- Coagulopathy: Coagulopathy is often associated with the traumatic event and may cause worsening of the neurologic injury, hemorrhage enlargement, and death. Acute TBI may cause coagulopathy itself through tissue factor and phospholipid release.
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