Long Brit, Koyfman Alex
Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
Emerg Med Clin North Am. 2018 Feb;36(1):107-133. doi: 10.1016/j.emc.2017.08.007.
Neurotrauma is a leading cause of death and is associated with many secondary injuries. A balance of mean arterial pressure (MAP) and intracranial pressure (ICP) is required to ensure adequate cerebral blood flow and cerebral perfusion pressure. Evaluation and management in the emergency department entails initial stabilization and resuscitation while assessing neurologic status. ICP management follows a tiered approach. Intubation requires consideration of preoxygenation, head of bed elevation, first pass success, and adequate analgesia and sedation. Early consultation with neurosurgery is needed for definitive therapy. Focused evaluation and management play a significant role in optimizing patient outcomes.
神经创伤是死亡的主要原因之一，并与许多继发性损伤相关。需要平衡平均动脉压（MAP）和颅内压（ICP），以确保充足的脑血流量和脑灌注压。急诊科的评估和管理需要在评估神经状态的同时进行初始稳定和复苏。颅内压管理采用分层方法。插管需要考虑预充氧、床头抬高、首次插管成功以及充分的镇痛和镇静。明确治疗需要尽早咨询神经外科。有针对性的评估和管理在优化患者预后方面发挥着重要作用。
