.
First-line therapy consists of repetitive fluid boluses with crystalloids.
Pure α-adrenergic sympathomimetics are the vasopressor drugs of choice.
Tachycardia and hypotension are pathognomonic signs of neurogenic shock.
The absence of a cervical collar can be used to rule out neurogenic shock.
Dopamine is the preferred vasopressor agent.
Hemicraniectomy is first-line therapy for elevated ICP.
Hypertonic saline is superior to mannitol for osmotherapy
Prolonged hyperventilation is a benign method for lowering elevated ICP.
Maintenance of elevated cerebral perfusion pressure (CPP) may be more important in improved neurologic outcome at the expense of high ICP.
Persistent hyperventilation is a terrific method to sustain alkalization and combat acidosis in the brain for long periods.
Hypotension is often the direct result of intracranial trauma.
Decerebrate posturing is a common response to diffuse cortical injury.
A score of 5 on the GCS is associated with a poor prognosis.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) should be suspected when the serum sodium level exceeds 150 mEq/L.
Brain injury takes predominance over any other injury, and therefore initial evaluation and management should focus only on the neurologic examination.
CT should be performed to exclude the diagnosis of intracranial hemorrhage or a mass lesion before starting therapy
Cerebral edema caused by head injury is vasogenic and not cytotoxic in origin.
Steroids are useful for the treatment of head trauma.
Hypercapnia induces cerebral vasoconstriction and is useful for decreasing intracerebral blood volume.
Within a few hours (1 to 3 hours) after injury, maximal cerebral edema has already formed, so further monitoring is unnecessary if the patient is clinically stable.
Most are caused by basilar skull fractures and close spontaneously.
The risk for infection is greater with rhinorrhea than with otorrhea.
They often do not require immediate surgical repair to avert infection.
They may be observed for up to 14 days if there is no evidence of infection.
The presence of a traumatic CSF leak mandates the use of prophylactic broad-spectrum antibiotic coverage.
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