Prise en charge des traumatisés crâniens graves

During the past two decades, understanding of the pathophysiology of traumatic brain injury was remarkably improved. One central concept is now well established: all neurological damage does not occur at the moment of the impact, but rather evolves over the ensuing hours and days. This secondary brain injury can result in increased mortality and more disabling injuries. Early post-injury episodes of hypotension or hypoxia or the both greatly increase the risk of ischemic secondary brain injury. The fundamental goals of resuscitation are the restoration of blood pressure, oxygenation and ventilation. ICP monitoring is necessary for the management of patients with severe head injury. Trans cranial Doppler is a useful tool in such management.