Management of traumatic brain injury: first link in chain of survival

Traumatic brain injury is a significant cause of morbidity and mortality. The prehospital care of the patient with a traumatic brain injury is critical to maximizing the chances for a good outcome. Prehospital management of the traumatic brain injury patient is directed toward preventing and limiting secondary brain injury while facilitating rapid transport to an appropriate facility capable of providing definitive neurocritical care. Key points in management include the assessment of oxygenation, blood pressure, and mental status (as measured with the Glasgow Coma Scale) and the pupillary examination. Treatment strategies are directed toward maintaining adequate oxygenation and perfusion and treating herniation. Judicious use of temporary hyperventilation and hypertonic saline are considerations. This review provides the most recent evidence regarding the treatment of traumatic brain injury in the prehospital setting and introduces areas in need of future research.