Early management of head injury

Patients with head injury need effective help. The restoration of disturbed ventilation and an impaired general circulation is important. Concomitant injuries, which occur in about 40% of cases, should be recognized. Priority must be given to treating large lesions of vital organs. Hypoxia and hypotension should be avoided because they produce secondary brain damage. Unconscious patients are intubated and ventilated. In a few cases a laryngeal mask could be applied. Intravenous hypnotics, narcotics and benzodiazepines are used. Inhalational anesthetics, among them N2O, are harmful and should be avoided in these cases. The patients are given normal volumes of colloid fluids or water electrolyte solutions. A long-lasting muscle relaxation will impede clinical assessment. Cerebral protection and effective drug treatment of the lesions is still under debate: Nimodepine in traumatic SAH and glucosteroids in local lesions with BBB rupture, however, seem to be effective.