Traumatic Epidural and Subdural Hematomas

2019 ◽  
pp. 614-620
Author(s):  
Patrick R. Maloney ◽  
Michelle J. Clarke
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Edema ◽  
Subdural Hematoma ◽  
Epidural Hematoma ◽  
Nonoperative Management ◽  
Mass Effect ◽  
Increased Intracranial Pressure ◽  
Cerebral Herniation

Traumatic brain injury is a broad topic and encompasses a spectrum of pathophysiologic disorders that result in increased intracranial pressure (ICP), cerebral edema, bleeding, mass effect, cerebral herniation, and death. Traumatic epidural hematoma (EDH) and subdural hematoma (SDH) are the focus of this chapter. EDH and SDH are intracranial blood collections that have mass effect within the intracranial vault (Figure 88.1) for which operative and nonoperative management criteria are established.

scholarly journals Prehospital management of traumatic brain injury

2008 ◽  
Vol 25 (4) ◽  
pp. E5 ◽  
Author(s):  
Shirley I. Stiver ◽  
Geoffrey T. Manley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Prehospital Care ◽  
Major Determinant ◽  
Neurological Injury ◽  
Raised Intracranial Pressure ◽  
Long Term Outcome ◽  
Cerebral Herniation ◽  
Prehospital Management

The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

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