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Current Level of Prehospital Care in Severe Head Injury — Potential for Improvement

  • P. Sefrin
Conference paper
Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 57)

Abstract

The fact that 50–60% of cases with severe head injury result from traffic accidents underlines the great significance of emergency care and of its organization. Many patients with severe head injury are threatened from vital complications diagnosed with delay, or not at all, which plays a major role not only for survival but also for the quality of recovery and regaining of employment capabilities. Thus, the necessity of qualified and trained physicians with experience in emergency care is obvious. Emergency care can be divided into an early resuscitation phase of securing or reestablishment of general vital functions, and a following stabilisation phase with administration of measures directed towards the specific conditions underlying trauma.

  1. 1.

    Prevention and treatment of respiratory complications. In addition to classical emergency care measures, endotracheal suction might be employed. The most effective method for clearance of airways and, thus, securing of the cerebral oxygenation is endotracheal intubation. Early intubation provides also for control of the intracranial pressure by hyperventilation and administration of O2. Recently assistant ventilation is available as compared to the past when only controlled ventilation was possible.

     
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    Circulatory support. A major requirement for a sufficient cerebral perfusion is an adequate cerebral perfusion pressure making necessary early fluid substitution. In case the patient is in circulatory shock, shock-specific treatment may compete with adequate positioning of the patient.

     
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    Pharmacological treatment in the prehospital phase. Although dexamethasone has been reported to directly influence brain edema, its benefits in head injury are not clear. Currently conducted clinical studies using markedly higher doses may provide so far missing information. Benzodiazepines might be given for sedation, while administration of barbiturates for cerebral protection has not been found effective under these circumstances, although barbiturates should be administered in seizures. Patients presenting with psychomotoric unrest or a low blood pressure may be subjected to a combination of analgesia and sedation.

     

Taken together, early implementation of competent prehospital emergency treatment may not only prevent acute life threatening complications on the scene, but also provide the basis for successful administration of definite conservative or surgical care after admission to the hospital.

Keywords

Traffic accidents head injury prehospital emergency care 

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Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • P. Sefrin
    • 1
  1. 1.Institute of AnaesthesiologyUniversity of WürzburgWürzburgFederal Republic of Germany

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