Triage and management of cranial injuries

This article discusses basic head and intracranial CNS anatomy, cerebral physiology, and classifications of head injury. Management principles and the practice of head-injury evaluation are reviewed and supplemented by the presentation of selected head-injury scenarios. The optimal evaluation and treatment of the head-injured patient is predicated on initially following established ATLS principles and preventing secondary injury. Once specific injuries have been identified, maintenance of cerebral perfusion and oxygenation is the key to maximizing patient outcomes, and this often requires measurement and treatment of ICP values. When significant mass lesions are identified or ICP elevations become refractory to medical intervention, surgical intervention is necessary.