ACP Medicine
نویسنده
چکیده
Traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the United States; the total national cost of TBI is more than $39 billion a year. Elucidation of the pathophysiology of brain injury is an important challenge for physicians who care for TBI patients. Equally important are prevention and a better scientific understanding of recovery and rehabilitation. TBI is now generally viewed as a multidimensional, dynamic process. It is not unusual for a patient with TBI who initially is relatively stable and awake or in a light coma to deteriorate rapidly. Delayed hematoma or expanding contusions that are amenable to surgery account for many such cases. Others are related to uncontrolled brain swelling that may not respond to conventional management. Delayed secondary injury at the cellular level is also a major contributor to brain swelling and tissue loss after TBI. The ultimate pathologic picture thus evolves during the first few hours and days after trauma, and the physiologic, clinical, and behavioral aspects of recovery can continue for years. For these reasons, therapy should be predicated on an understanding of the multidimensional pathology of TBI and its evolution. TBI is traditionally classified by its severity [see Table 1], though the current definitions are imperfect and distinctions between mild, moderate, and severe head injury can be difficult to make in the acute period. For example, acute management of an unconscious patient with a moderate head injury may differ little from that of a comatose patient with a more severe head injury; or a patient with little or no initial loss of consciousness may harbor a more serious and even life-threatening pathology, such as a delayed hematoma. Nevertheless, the distinctions are generally useful in guiding the approach to the patient.
منابع مشابه
Advances in evidence-based information resources for clinical practice.
Readers with a critical eye for value will quickly discern that ACP Journal Club just got bigger and better. The usual 25 pages of abstracts in each issue have been expanded to 37 by adding 12 pages of unique content from ACP Journal Club’s sister journal, Evidence-Based Medicine. This additional content covers advances of relevance to primary care specialists in the fields of family medicine, ...
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