Head Trauma

INTRODUCTION

For those older than 45, trauma is one of the top five causes of death. The management of patients with traumatic injuries presents a variety of challenges. Patients require multidisciplinary evaluation, securing the airway and breathing, hemorrhage control, resuscitation, and stabilization in the emergency department and possible operative intervention prior to inpatient admission. For the combined burn/trauma patient, the immediate management priority is stabilization and resuscitation of the patient from a trauma/management of injury perspective. Management of the burn wounds is a secondary priority. Patients remain at risk for complications due to unrecognized injuries or related to initial or ongoing management.

●Initial assessment – The injured patient admitted from the emergency department or operating room warrants full reassessment of the medical history. Patients with alcohol or drug use disorder are more likely to have complications during their hospital stay, while patients with medical comorbidities have an increased risk of mortality.

●Repeat assessment – Repeat head-to-toe trauma examination (tertiary survey) on all patients decreases the frequency of missed injuries. Missed injuries are more common in multiply injured patients who require emergent surgical intervention shortly after hospital arrival. Extremity injuries are commonly missed. Significant injuries that can be missed during the initial evaluation include intra-abdominal injury, diaphragm injury, pulmonary contusion, arterial injury, and intracranial injury.

●Preventive strategies – Preventive strategies are important to reduce the incidence of common complications and include monitoring to identify and treat extremity and abdominal compartment syndromes, as indicated by the patient's injuries, and prophylactic therapies such as antibiotics prior to surgical intervention, thromboprophylaxis, stress ulcer prophylaxis, steroid prophylaxis for those on chronic therapy, and prophylaxis for drug/alcohol withdrawal.

●Complications – Complications that may arise in injured patients are often related to specific injuries (eg, biliary fistula) but may also be due to incomplete or absent prophylaxis (eg, deep vein thrombosis), lack of monitoring (eg, abdominal compartment syndrome), or complications arising from diagnostic and resuscitative efforts (eg, contrast-media-associated nephropathy, transfusion-associated acute lung injury), prolonged ventilation (eg, ventilator-associated pneumonia), or immobilization (eg, pressure ulcers).