New perspectives in the management of adults with severe head injury.

Traditional treatment options for the adult with severe head injury have included hyperventilation, elevation of the head of the bed, sedation, chemical paralysis, fluid restriction, diuresis, anticonvulsant therapy, and barbiturate coma. These interventions for severe head injury are reviewed and updated with current research. Neuroprotective drugs (including glutamate antagonists, oxygen free radical scavengers, and high dose steroids) are introduced, along with monitoring of jugular venous oxygen saturation and the role of the transcranial Doppler. The role of the critical care nurse in the treatment and monitoring of the adult with severe head injury is discussed.