be nursed postoperatively in the intensive care unit (ICU), if one exists in your hospital. • Head dressing — a bandage to keep the head injury or surgical incision clean and dry. The brain is an obligate glucose user. Again, there is little evidence in terms of improved outcome to support this. If the ICP remains difficult to control, a thiopental infusion may be used in conjunction with electroencephalographic (EEG) monitoring to bring about burst suppression. However, this may or may not be the tissue involved in the head injury, and interpretation of pressure readings may be difficult if the monitor is sited in the middle of an expanding contusion. After a severe brain injury, the brain may start to swell and the patient's condition may deteriorate as the hours go by. New York: Brain Trauma Foundation and the American Association of Neurological Surgeons. An increase in serum osmolality will result in a tendency to decrease brain tissue water and hence decrease ICP. All five key principles of care can be offered by any ICU. Rapid neurological assessment, including checking for pupillary response, corneal, cough, gag, motor exam, reflexes, rectal tone). They proposed a treatment protocol that included the following: Head injury patients should be taken directly to a centre which can provide resuscitation and management of head injuries and trauma leading to multiple injuries. What it is A guideline for the multidisciplinary management of patients with a Traumatic Brain Injury (TBI). Once the severely head-injured patient has been transferred to the ICU, the management consists of the provision of high quality general care and various strategies aimed at maintaining hemostasis with: 7. preservation of normal colloidal-absorbing force; a reduction in intracapillary pressure by antihypertensive therapy using clonidine and metoprolol; a simultaneous moderate constriction of the precapillary resistance vessels with low-dose thiopental and dihydroergotamine; and. In some units, neuromuscular blockers are used as standard; in others, they are used when ICP remains difficult to control, all other medical measures are in place and there is a concern that muscle activity may be contributing to the pressure. One percent of all deaths in the UK are attributed to head injury; up to 85% of all severely head-injured patients remain disabled after 1 yr and only 15% have returned to work at 5 yrs. It is important for anyone suffering a head injury and traumatic brain injury to be closely monitored especially for the first 24 hours. They also hypothesized that the use of vasopressor agents may enhance the vasoconstrictor response that is likely to be present after trauma. Before concluding this review of head-injury management, with its many references to the lack of available data, it is worth considering why head-injury research is so difficult. Basic demographic, clinical, biological, and radiological data were recorded on admission and during the ICU stay. ADVERTISING MATERIALBrought to you by The Brain Injury Law Group, SC. Neuroscience ICU nurses have an integral role in the care of the critically ill TBI patient. 2014). Very often, we imagine intensive care to be a transitory speciality, which is sometimes true, in the case of a heart attack, for example, where every minute spent without care or without first aid is vital. 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