Management of the Multiple Trauma Patients with Traumatic Brain Injury(<SPECIAL ISSUE>Traumatic Brain Injury: Recent Advances)

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  • Wakasugi Masahiro
    Department of Crisis Medicine, Graduate School of Medicine, University of Toyama
  • Okudera Hiroshi
    Department of Crisis Medicine, Graduate School of Medicine, University of Toyama

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  • 頭部外傷を含む多発外傷患者の対応と問題点(<特集>頭部外傷の最新の知見)

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Traumatic brain injury (TBI) is a major cause of death, and nearly one third of severe TBI patients have multiple life-threatening injuries. When treating multiple trauma patients to prevent secondary brain injury, securing the airway and maintaining adequate breathing and circulation are the first priorities. The Japan advanced trauma evaluation and care (JATEC) guideline is an effective tool to better understand the management of multiple trauma patients. The JATEC recommends a linearly-ordered procedural algorithm, in the from of a Primary Survey and Secondary Survey. The Primary Survey contains a series of procedures to resuscitate and maintain the patient's general status. The patient's detailed mental status should be assessed after stabilization of respiration and circulation in the Primary Survey. CT diagnostic imaging for TBI is taken after the Primary Survey as the first step of the Secondary Survey. How and when to operate on a patient with unstable hemodynamics and worsening consciousness disturbance remains controversial.

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