初期診療から専門診療への連携

Collaboration Between Initial the Definitive Management in Traumatic Brain Injury

Point

・外傷診療は時間との勝負である．迅速な初期蘇生はもちろんのこと，正確な重症度，緊急度の評価は必須である．

・根治的治療がシームレスに継続されるための情報伝達項目を明確にしておく．チーム医療（戦略，戦術，チームワーク）の確立は必須である．

・搬送を急ぐあまり，気道，呼吸，循環の安定化を怠ってはならない．付加的な二次的脳損傷は患者転帰をむしろ悪化させる．

　To avoid preventable trauma death（PTD）, initial management, including resuscitation, is crucial in traumatic brain injury（TBI）care. PTD is defined as a case in which the percentage of probability of survival exceeds 50%, but the patient unfortunately dies without appropriate treatment. To diminish cases of PTD, a standardized approach has been established with several training courses and guidelines. However, 20% of all patients with TBI experience PTD. In our study, PTD cases accounted for 26.2% of all cases of so-called “talk and deterioration.” Additionally, anti-coagulation/anti-platelet users comprised 26.8% of all PTD cases. Thus, to eliminate PTD, measures against anti-coagulants are important. Moreover, quick decision making regarding treatments preceding the rapid-changing pathophysiology is also essential in TBI care. In addition to securing airway management, providing oxygen support, and stabilizing circulation, timely administration of a neutralizer for anti-coagulative drugs and use of tranexamic acid（a drug for anti-fibrinolysis）is crucial.

　In this chapter, the pearls of initial TBI management are mentioned, with focus on the “first hour” of treatment.