(DOWNLOAD) "Targeted Treatment of Severe Head Injury: Head Injury is Poorly Classified for Treatment and So Its Categorisation is Not as Useful as It Could Be to Guide Therapy (Report)" by Anthony A. Figaji * Book PDF Kindle ePub Free
eBook details
- Title: Targeted Treatment of Severe Head Injury: Head Injury is Poorly Classified for Treatment and So Its Categorisation is Not as Useful as It Could Be to Guide Therapy (Report)
- Author : Anthony A. Figaji
- Release Date : January 01, 2010
- Genre: Health & Fitness,Books,Health, Mind & Body,
- Pages : * pages
- Size : 85 KB
Description
It has been increasingly appreciated in recent times that head injury is not a homogeneous concept and is poorly classified for the purposes of treatment. (1) The separation of patients into 3 categories of severity (mild, moderate and severe) remains a blunt measure used to guide therapy in individual patients. Patients with severe traumatic brain injury (TBI), i.e. a Glasgow Coma Score (GCS) [less than or equal to]8, may have different pathologies, including an extradural haematoma, subdural haematoma, cerebral ischaemia, cerebral hyperaemia, vasospasm, diffuse axonal injury, and/or focal haemorrhagic contusions. Moreover, autoregulation of the links between cerebral blood flow (CBF) and blood pressure, carbon dioxide tension, and cerebral metabolic requirements may be variably impaired in individuals--all of which have major implications for treatment. Yet traditional management tends to treat all individuals similarly. For example, intracranial pressure (ICP) is usually treated in a standardised stepwise approach. Yet in individual patients, elevated ICP may be associated with cerebral hyperaemia or cerebral ischaemia, subclinical seizures, or impaired autoregulation (where it is the elevated blood pressure that is the underlying problem). To target these appropriately would require accurate diagnosis and a different approach to management. Alongside this recognition of the heterogeneity of head injury is the growing appreciation of the role of secondary injury in determining outcome. Secondary injury accounts for everything that occurs after the primary injury that contributes to worsening brain damage. It may take the form of pathophysiological events initiated by the primary injury (such as brain swelling due to biochemical cascades), or secondary insults at a time when the brain is vulnerable, such as hypotension and hypoxia. Secondary injury represents an opportunity to intervene and improve outcome, but our tools for recognising it before damage has been done have been poor. Recent advances in the intensive care unit (ICU) environment, however, have improved our ability to detect potential secondary injury early and avoid its consequences.
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