Severe head injury: prehospital and emergency department management

Head trauma causes approximately 75,000 deaths each year in the United States. Both hypoxia and hypovolemia are individual predictors of poor outcome in the patient with severe head trauma. Management begins in the field and is focused on ensuring oxygenation and maintaining a blood pressure that supports cerebral perfusion. In the trauma center, intracranial pressure monitoring may be helpful in guiding the management of increased intracranial pressure. Mannitol, given in intermittent bolus infusions, is the therapy of choice for increased intracranial pressure. Hyperventilation has been shown to decrease cerebral perfusion and should be avoided; it is a temporizing procedure that is reserved for those cases that demonstrate signs of increased intracranial pressure pending initiation of other therapies.