Key Points:
1. Rapid identification of severe traumatic brain injury in the field should prompt rapid transport to a Level I trauma center if possible.
2. Assume concomitant cervical spine injury and use full spinal precautions throughout assesment and treatment.
3. Identify and treat other traumatic injuries simultaneously.
4. Avoid hypotension and hypoxemia.
5. Endotracheal intubation by EMS should only be performed when adequate airway or oxygenation is not otherwise possible.
6. Avoid prophylactic or inadvertent hyperventilation.
7. Resuscitation of shock should follow ATLS protocols, using saline and blood products when necessary.
8. Non-contrast CT scanning offers the most rapid delineation of brain injury.
9. Intracranial pressure monitoring should be obtained early, and appropriate cerebral perfusion pressures should be maintained.
10. Sedation with opiates, benzodiazepines, and low dose propofol should be used when intra¬cranial hypertension is present; care must be taken to treat resulting systemic hypotension.
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