Articles: brain-injuries.
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As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. ⋯ Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.
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An estimated 60,000 patients with severe head injury reach the Emergency Department alive each year; 50% of these patients have significant elevations in intracranial pressure at or shortly after arrival. Aggressive emergency department management with particular attention to airway management, control of intracranial pressure, and proper use of radiographic studies is crucial to successful neurologic recovery.
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Critical care medicine · Feb 1993
Comparative StudyAutonomic cardiovascular state after severe brain injury and brain death in children.
To study and compare the autonomic cardiovascular state of children after severe brain injury and brain death. ⋯ Our results support the concept of a damaged sympathetic cardiovascular system in severe brain injury and complete interruption of the autonomic cardiovascular pathways in brain death. Since determination of brain death may be difficult, our findings have implications for corroborating brain death using autonomic cardiovascular testing.
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Traumatic injuries to the brain or spinal cord cause irreversible tissue damage by at least three mechanisms: through consequences of mechanical disruption of neurons or their projections; through biochemical or metabolic changes that are initiated by the trauma; and through reactive inflammatory or gliotic changes. During the past decade, considerable data have been accumulated regarding cellular and biochemical events associated with posttraumatic tissue damage. This has led to the application of pharmacological strategies to limit secondary injury and subsequent neurological deficits. Such research has resulted in the first effective treatment of human spinal cord injury, with other promising treatments in late preclinical or early clinical development.