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Operational Anaesthesia for the Management of Traumatic Brain Injury
  1. CL Park, London HEMS Registrar,
  2. P Moor, Consultant in Neuroanaesthesia2,
  3. K Birch, Consultant3 and
  4. Wg Cdr PJ Shirley, Consultant4
  1. 2MDHU Derriford
  2. 3Intensive Care and Anaesthesia, Frenchay Hospital, Bristol
  3. 4Intensive Care and Anaesthesia, Royal London Hospital, Whitechapel, London E1 1BB Peter.Shirley{at}


The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the headinjured patient the best chance of recovery.

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