TRAUMATIC BRAIN INJURY: INITIAL APPROACH AND MANAGEMENT IN THE EMERGENCY ROOM

Abstract

Traumatic brain injury (TBI) is a frequent condition in the emergency room and represents a significant cause of morbidity and mortality, especially in victims of high-energy trauma, falls, traffic accidents, and elderly patients. This chapter systematically addresses the initial assessment and management of TBI, highlighting the importance of care based on the ABCDEs of trauma, cervical spine protection, airway maintenance, oxygenation, ventilation, and cerebral perfusion. The pathophysiology of primary and secondary injuries, classification using the Glasgow Coma Scale, signs of severity, indications for non-contrast head CT scans, and the main traumatic intracranial lesions are also discussed. The text emphasizes the management of mild, moderate, and severe TBI, the prevention of hypoxia and hypotension, the recognition of intracranial hypertension, the judicious use of hyperosmolar therapies, the approach to anticoagulated patients, the role of tranexamic acid in selected cases, the prevention of post-traumatic seizures, and the criteria for discharge, observation, hospitalization, and neurosurgical evaluation. It concludes that early, organized, and multidisciplinary care is essential to reduce the progression of secondary brain injury, improve neurological prognosis, and decrease complications associated with TBI.