Articles: traumatic-brain-injuries.
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The risk of deep vein thrombosis is increased in patients with head trauma, but the prophylaxis against this event is confronted with the possible risk of worsening hemorrhagic injuries. In this article, we present an overview about deep vein thrombosis prophylaxis in patients with head trauma and we propose a practical protocol for clinical management of deep vein thrombosis prophylaxis. ⋯ Head trauma alone is a risk factor for deep vein thrombosis and pulmonary thromboembolism and the risks inherent in this disease requires methods of prevention for these complications. Clinical trials are needed to establish the efficacy of prophylaxis and the best time to start medication for deep vein thrombosis in patients with traumatic brain injury.
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Concussions are common injuries with increasing diagnostic incidence. The 4th International Conference on Concussion in Sport, held in November 2012 in Zurich, revised consensus statements regarding the definition of a concussion, diagnostic criteria, and management. ⋯ Rhode Island enacted into law the School and Youth Programs Concussion Act in 2010, which increases awareness of concussions for athletes, coaches, teachers, school nurses and parents/guardians through written information and mandatory training for coaches. Athletes must be removed from practice/competition and cannot return until a physician has evaluated and cleared them. [Full text available at http://rimed.org/rimedicaljournal-2015-02.asp, free with no login].
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Expert Rev Neurother · Feb 2015
ReviewFurther understanding of cerebral autoregulation at the bedside: possible implications for future therapy.
Cerebral autoregulation reflects the ability of the brain to keep the cerebral blood flow (CBF) relatively constant despite changes in cerebral perfusion pressure. It is an intrinsic neuroprotective physiological phenomenon often suggested as part of pathophysiological pathways in brain research. ⋯ In this article, we attempt to answer this question by demonstrating how cerebral autoregulation assessment can have prognostic value, indicate pathological states, and potentially even influence therapy with the use of the 'optimal cerebral perfusion pressure' paradigm. Evidence from the literature is combined with bedside clinical examples to address the following fundamental questions about cerebral autoregulation: What is it? How do we measure it? Why is it important? Can we use it as a basis for therapy?
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Review
Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?
Intracranial hypertension, defined as an intracranial pressure (ICP) >20 mmHg for a period of more than 5 min, worsens neurologic outcome in traumatic brain injury (TBI). While several mechanisms contribute to poor outcome, impaired cerebral perfusion appears to be a highly significant common denominator. Management guidelines from the Brain Trauma Foundation recommend measuring ICP to guide therapy. In particular, hyperosmolar therapy, which includes mannitol or hypertonic saline (HTS), is frequently administered to reduce ICP. Currently, mannitol (20%) is considered the gold standard hyperosmolar agent. However, HTS is increasingly used in this setting. This review sought to compare the efficacy of mannitol to HTS in severe TBI. ⋯ While all seven studies found that both mannitol and HTS were effective in reducing ICP, there was heterogeneity with regard to which agent was most efficacious.
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Each year close to 20000 Americans are involved in gunshot wounds to the head (GSWH). Over 90% of the victims of GSWH eventually fail to survive and only a meager 5% of the patients have a chance to continue with a useful life. One of the fundamental jobs of providers is to realize who the best candidate for the best possible management is. ⋯ In case of a positive study, these patients should have endovascular management of their vascular injuries in order to prevent catastrophic intracerebral hematomas and permanent deficit. Although supported by class III data, subjects of GSWH need to be on broad spectrum antibiotics for a period of 3-5 days. If cerebrospinal fluid (CSF) fistulas are observed at any time during the patient's hospital course, they should be taken very seriously and appropriate management is needed to prevent deep intracranial infections.