Surgical management of patients with severe head injuries

This descriptive paper recognizes the collaborative approach to the perioperative care of the severely brain-injured patient, defined as GCS < 8 by the authors, while addressing specific perioperative nursing interventions for the head injured patient. Many useful adjuncts to the text have been provided such as a mini glossary that includes the common operative neurosurgical procedures, terms, and vital neurological assessment findings. The authors discussion begins with assessment of the initial injury, moves through the preoperative, intraoperative, and postoperative management, and concludes with recent technologic adjuncts in neurotrauma care. Radiographic assessment is considered, as is the maintenance of a neutral head position due to the time limitation in obtaining detailed C-spine analyses. Discussions are presented of specific operative injury criteria requiring immediate surgical interventions. Concise anatomic descriptions distinguish subdural, epidural, and intracerebral hematomas along with the probable vascular insult. The surgical approach to each type of hematoma evacuation is provided. Surgical debridement and irrigation of penetrating head injuries are detailed.