The management includes pre-hospital care and triage, initial management at combat sector hospital and finally evacuation for definitive management at tertiary care hospital. The management of head injuries is aimed at preventing secondary injury. Types of secondary brain injury are: (a) Intra cranial hematomas, (b) Cerebral edema, (c) Ischemia, (d) Infection, (e) Epilepsy/seizures and (f) Metabolic/endocrine disturbances. Hypotension and hypoxia are the two most acute and easily treatable mechanisms of secondary injury. It is defined as subsequent or progressive brain damage arising from events developing as a result of the primary brain injury. Secondary brain injury results from disturbance of brain and systemic physiology by the traumatic event. Enforcement of personal protective measures (helmet) by the command is essential prevention. Very little can be done by healthcare providers to influence the primary injury. Types of primary brain injury are: (a) Diffuse axonal injury: results from shearing of grey-white matter interface (b) Cerebral concussion: defined by a period of amnesia, (c) Cerebral contusion and (d) Laceration. Primary brain injury: is caused at the time of impact and is a function of the energy transmitted to the brain by the offending agent. Symptoms are also dependent on the injury's severity. Symptoms are dependent on the type of TBI (diffuse or focal) and the part of the brain that is affected. This is called the Kellie-Monro principle and implies that changes in one of the intracranial components will result in compensatory alteration in the others. Therefore, maintenance of adequate BP is of vital importance for brain survival.īecause the cranium is a closed space, the sum of the intracranial volumes of brain, blood, cerebrospinal fluid (CSF), and other components (e.g., hematomas, mass lesions) are constant. However, under traumatic conditions, autoregulation is lost, resulting in a linear relationship of BP to cerebral blood flow. This phenomenon is called cerebral autoregulation and means that changes in CPP between 50 mm Hg and 150 mm Hg do not cause significant changes in the cerebral blood flow. Ĭerebral blood flow is kept stable under normal conditions due to linear changes in cerebrovascular resistance. CPP should be maintained at higher than 70 mm Hg in adults and at higher than 60 mm Hg in children. Cerebral perfusion pressure (CPP) equals mean blood pressure (BP) minus ICP. Intracranial pressure (ICP) is the normally positive pressure present in the cranial cavity ranging from 5 mm Hg in an infant to 15 mm Hg in an adult.
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