Advances in the management of head injury

López Fajardo P, Lubillo Montenegro S

Head injuries have a profound societal impact given that they are the leading cause of

death in persons under 45 years of age and the third leading cause overall. To this, we

must add the family, social, and financial burdens of survivors who suffer sequelae. Most

pathophysiologic changes in cerebral metabolism and blood flow occur in the first few

hours after injury. Early management by emergency services and in hospital emergency

departments therefore plays a key role in determining prognosis. Although the primary

injury cannot be undone, we can limit its progression by minimizing secondary brain

damage. From the moment of first response to the patient, once basic resuscitation

measures have been taken, the main goal should be to stabilize the patient, especially

preventing hypotension and hypoxia, which are independent risk factors for morbidity and

mortality. Patients with severe head injury must be transported in stable condition to a

tertiary care hospital with a neurosurgery department and an intensive care unit that can

monitor such neurologic variables as intracranial pressure and cerebral oxygenation. This

review of head injury management addresses 2 aspects that are essential for treatment. We

first describe pathophysiologic concepts that influence cerebral blood flow and metabolism

and intracranial pressure, and we also cover types of primary and secondary injuries. We

then discuss evaluation and management more thoroughly, including measures in

prehospital and emergency department settings, as well as intensive care unit treatment

involving multimodal neurologic monitoring techniques.

Lubillo Montenegro S, López Fajardo P