Emergency management of head injuries

Sophisticated care of the head injury patient in the emergency department does not demand sophisticated knowledge of neurosurgery. Instead it depends upon: 1. (A) Meticulous attention to the fundamental principles of resuscitation; 2. (B) Prevention of secondary cardiopulmonary abnormalities which can further injure the traumatized brain; 3. (C) Performance of serial neurologic examinations. (In the case of acute head injury, a simple neurologic examination performed repeatedly usually provides the physician with more useful information than a more elaborate examination performed only once). 4. (D) Consultation with the neurosurgeon. If there is any possibility that neurosurgical consultation might enhance the emergency department management of the patient, one should not hesitate to contact him. There is no question that protocols for any phase of emergency management of central nervous system (CNS) trauma are of no value unless there is a high degree of compliance. This can only be achieved through persons dedicated to training emergency medical technicians, nurses and physicians in the optimal care that can be afforded these patients. If advances are to be made in decreasing the morbidity and mortality of the CNS trauma patient, those actively involved in emergency medicine are going to have to take an active role in training programs, seminars and clinical practice for physicians, emergency department nurses, and emergency medical technicians.