A practical approach to the management of head injuries in Papua New Guinea.

Traumatic brain injury (TBI) is one of 3 leading causes of deaths in the Surgery Department of Port Moresby General Hospital in the last 30 years despite being responsible for only 5% of admissions. It maims and kills the young. Most of these injuries and deaths can be prevented by addressing public health issues such as modifying people's lifestyles to avoid drink driving, wearing seat belts in vehicles and peaceful conflict resolution. Severe disabilities can be minimized by prompt and adequate management that prevents secondary brain injury. This is achieved by aggressive maintenance of normal cerebral oxygenation and blood pressure (BP) and optimization of intracranial pressure (ICP). These outcomes are achieved by ensuring that the airways are patent, with respiration assisted where necessary, and by the use of fluids or inotropes to maintain a normal BP. Prompt appreciation of mass lesions and their removal will optimize ICP, improve cerebral perfusion pressure (CPP) and oxygenation. Management of severe TBI involves appropriate use of ventilation and pharmacological agents to ensure ICP and CPP are optimized either in situations where surgery is not indicated or after decompressive surgery. The high morbidity and mortality posed by TBI can be reduced by addressing these issues in Papua New Guinea.