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Emerg Med Clin North Am. 2018 Feb;36(1):107-133. doi: 10.1016/j.emc.2017.08.007.

Secondary Gains: Advances in Neurotrauma Management.

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Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA. Electronic address:
Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.


Neurotrauma is a leading cause of death and is associated with many secondary injuries. A balance of mean arterial pressure (MAP) and intracranial pressure (ICP) is required to ensure adequate cerebral blood flow and cerebral perfusion pressure. Evaluation and management in the emergency department entails initial stabilization and resuscitation while assessing neurologic status. ICP management follows a tiered approach. Intubation requires consideration of preoxygenation, head of bed elevation, first pass success, and adequate analgesia and sedation. Early consultation with neurosurgery is needed for definitive therapy. Focused evaluation and management play a significant role in optimizing patient outcomes.


Intracranial pressure; Mean arterial pressure; Neurotrauma; Spinal cord injury; Tier; Traumatic brain injury

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