Challenges to Neurocritical Care Management in Polytrauma

Neurocritical care management of the polytrauma patient with neurologic injury demands a methodical, systems-based, multidisciplinary approach to optimize outcomes and minimize secondary harms. Hemodynamic stability is the linchpin of a complex decision tree. During initial resuscitation efforts, the clinician must maintain awareness of the impact any given action may have on the injured brain or spine and advocate for measures that are neuroprotective. Once life-threatening hemorrhage is controlled, further diagnostic evaluation and management of neurologic injuries may proceed. Care of the patient with comorbid brain and spinal injury requires navigating sometimes conflicting clinical objectives.