Il trauma cranico: Linee-guida essenziali per il trattamento sul territorio

The most important cause of head injury is a motor veichle accident. From this epidemiological aspect it appears useful a logistic and technical support to obtain a specific treatment as soon as possible. Pathologically, traumatic brain lesions can be divided in two main sections: immediate primary injury and secondary brain damage (systemic insult or local intracranial). Conditions as hypotension, hypoxia, hypercarbia, frequently associated with severe head injury lead to deranged cerebral perfusion and then cerebral ischemia. Neurological examination by Glasgow Coma Scale (GCS) permits a head injury assessment in the three levels: minor, moderate and severe. In severe head injury, the most important physiological parameters must be monitored and patient stabilization is important to prevent secondary brain damages. Cervical spine must be always stabilized by firm collar in those patients with severe trauma, who will be carried to the nearest equipped hospital (with availability of TC scan, neurosurgery department, resuscitation area). On arrival in the emergency department, it is important to carry out an aimed investigation. Evidence of a skull fracture increases the risk of neurosurgical complications. TC scan must be performed to patients with severe and moderate head injury and also to patients with GCS 14-15 with skull fracture.