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Chapter 11 - Management of traumatic brain injury

Published online by Cambridge University Press:  07 October 2011

S. Andrew Josephson
Affiliation:
University of California, San Francisco
W. David Freeman
Affiliation:
Mayo Clinic
David J. Likosky
Affiliation:
Evergreen Hospital Medical Center, Kirkland, WA
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Summary

Traumatic brain injury (TBI) remains a serious public health issue. It is the leading cause of both mortality and morbidity in the United States in 1-44 year old age group. Multitudes of pathophysiological injuries encompass traumatic brain injury. These include subdural and epidural hematomas, subarachnoid hemorrhage, contusions, global and regional cerebral edema, diffuse axonal injury, and vascular injury. Therapy is directed at preventing secondary brain damage by treating the evolving cascades of injury. Immediate and baseline supportive care is provided for all patients with moderate to severe head injury. Secondary brain injury may result from pre-hospital and in hospital hypoxemia and hypotension. Intracranial pressure (ICP) monitoring, with either a subarachnoid bolt or external ventricular drain (EVD), has become the standard of care for patients with severe head injury. Decompressive craniectomy (DC) involves removing a portion of the skull and allowing the edematous brain to swell outwards, thereby reducing intracranial pressure.
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Publisher: Cambridge University Press
Print publication year: 2011

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