Prise en charge initiale des traumatismes crâniens graves et monitorage avant l'arrivée en centre spécialisé

Although severe brain injuries are less frequent in developed countries, the use of guidelines to manage these patients would allow an important improvement in mortality and would have major economical consequences. Brain injured patients' mortality is correlated to Glasgow coma score. Monitoring of arterial blood pressure and maintenance of mean arterial pressure above 80 mmHg are mandatory. Every patient with bilateral mydriasis needs to benefit immediately from osmotherapy. Every comatose patient must be intubated and ventilated to avoid hypoxemia. Ventilator settings must avoid hypocapnia. All severely brain injured patients have to be admitted in a neurotrauma centre.