Crash course in head trauma Part 2: Treatment and diagnostic aids*

Traumatic brain injury is a dynamic process and therefore serial physical and neurological examinations are essential in order to appropriately assess and treat these patients. The majority of head trauma patients will be successfully and adequately managed in primary care facilities. However, referral to an intensive care unit in a timely manner should be considered in some patients. As detailed in part one of this series of articles, the initial (primary) brain injury is due to the direct head trauma (or contact injury) and is usually not amenable to therapy. However, these injuries can result in obvious externalwounds so it becomes important not to get carried away with management of these primary injuries. Management should instead be directed at the prevention of the secondary brain injury and supportive care. Imminently life threatening problems and those that quickly lead to secondary brain injury (e.g. hypoxia and hypotension) must also be assessed and treated quickly before therapy for the primary brain injury is instituted as discussed in part two of this series. This article describes the interventions that can be considered in patient management.