The initial management of head injury is very important to reduce the morbidity and mortality associated with the condition. The initial care impacts significantly on the eventual outcome and if not properly done, it may make nonsense of any eventual specialist neurosurgical care.

The key aspects in the management of patients following head injury involve:
• accurate clinical assessment of the neurological and other injuries
• determination of the pathological process involved
• accurate assessment of changes in the neurological status of the patient; this indicates an improvement, progression or change in the pathological processes.

At the injury site, immediate care involves careful extraction of the injured individual (e.g from a car wreck, collapsed building, gutters, etc), rapid restoration and maintenance of an adequate airway, protection of the cervical spine, ventilation, essential circulatory resuscitation, first aid treatment of other injuries and the urgent transfer of the patient to hospital.

It is essential to avoid hypoxia and hypotension as these will cause further brain
injury (secondary brain damage). The ‘ABC’ of resuscitation gives a good guide for the initial management of the head-injured patient like other trauma patients.

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