tailieunhanh - Traumatic brain injury - Introduction: Part 2

(BQ) Continued part 1, part 2 of the document Traumatic brain injury - Introduction has contents: Follow-up and community integration of mild traumatic brain injury, neuropsychiatric and behavioral sequelae, epidemiology of traumatic brain injury, rehabilitation of cognitive deficits after traumatic brain injury, and other contents. Invite you to refer. | CHAPTER 7 ICU care surgical and medical management neurological monitoring and treatment Luzius A. Steiner Department of Anesthesiology University Hospital of Basel Switzerland Injury resulting from traumatic insults to the brain is typically divided into primary and secondary injury. Primary injury occurs at the moment of the trauma and currently cannot be influenced in the clinical setting. In contrast secondary brain injury occurs at some time after the primary impact as a complication of primary injury and is potentially preventable and treatable. Secondary insults are classified as either intracranial or extracranial Table and have a major impact on outcome. The goal of neuromonitoring and neurological intensive care treatment in patients with traumatic brain injury TBI is to prevent or if that is not possible to rapidly recognize and treat secondary insults. Neuromonitoring Clinical neuromonitoring Clinical deterioration is often the first sign of a secondary insult such as a rise in intracranial pressure ICP or developing intracerebral hematoma. This underlines the importance of repeated standardized neurological assessments to detect such a clinical deterioration as early as possible. Standardized scoring systems facilitate quantitative reporting of the neurological status and are indispensable if the neurological status needs to be compared to earlier assessments. The most widely used score is the Glasgow Coma Scale GCS .Of the three components of the GCS the motor score is considered to be the most important. Recently a new coma scale has been introduced the Full Outline of UnResponsiveness FOUR score 1 . It addresses some of the shortcomings of the GCS by including brainstem reflexes and respiration allowing detection of subtle neurological changes and thus further classification of deeply comatose patients. A comparison between the GCS and the FOUR score is shown in Table . While such scores are Traumatic Brain Injury First Edition. Edited by .