Traumatic brain injury: initial resuscitation and transfer

Traumatic brain injury (TBI) is a major cause of mortality and morbidity in the young adult population. Targeted resuscitation with the aim of avoiding hypoxia and hypotension – two of the most important determinants of secondary brain injury – can produce significant improvements in outcome. Guidelines exist to aid the structured conduct of this resuscitation and then to aid the planning and execution of safe transfer for definitive management. However, there remains recurring problems with both the initial resuscitation and the transfer. This article addresses these common problems, and in conjunction with the referenced guidelines provides the basis for local treatment and transfer algorithms to deliver adequately resuscitated TBI patients, safely, to a neurosurgical centre for definitive care.