Initial Management of Traumatic Brain Injury : To Reduce Preventable Trauma Death

Abstract

  To avoid preventable trauma death (PTD), initial management, including resuscitation, is crucial in traumatic brain injury care. PTD is defined as a case in which the probability of survival exceeds 50% but unfortunately death occurs unless appropriate treatments are available. To diminish the cases of PTD, a standardized approach has been established with several training courses and guidelines. However, 20% of all traumatic brain injury (TBI) patients still suffer from PTD. Our research clarified that the cases of so-called “talk and deterioration” accounted for 26.2% of the PTD cases. In addition, 26.8% of PTD cases were anti-coagulant/anti-platelet drug users. Therefore, to eliminate PTD, measures against anticoagulation are important. Moreover, quick decision making regarding treatments preceding the rapid-changing pathophysiology is also essential in TBI care. In addition to securing airway, breathing support, stabilization of circulation, timely administration of neutralizers for anti-coagulative drugs, and the use of tranexamic acid, a drug for anti-fibrinolysis, is also significant.

  In this chapter, the pearls of initial TBI management are mentioned, with focus on the “first one hour” of treatment.