Injuries to the brain and spinal cord need prompt attention after an accident, while those that involve nerves require elective procedures that can be deferred for treatment until the condition of the patient becomes less critical. After severe head injuries primary consideration should be given to the danger of intracranial hemorrhage, to wounds requiring débridement and closure, and in general to the needs of a comatose patient. Deepening coma and other signs may warn of progressive hemorrhage or edema with the development of a lethal pressure cone. Compression of the midbrain may develop so rapidly that evacuation of an extradural hematoma must sometimes be undertaken without waiting for an x-ray, if life is to be saved. Patients who have suffered fracture or dislocation of vertebrae require the greatest care during transportation to prevent further damage to the spinal cord. Respiration must not be depressed by ill-advised use of morphine; it may need to be assisted by oxygen administration, or suction, or tracheotomy. Early operation is required only for compound wounds, irreducible dislocations, and persistent cord compression. In the case of a cervical cord injury this should be deferred until the critical period of respiratory and circulatory depression has passed. In most of these spinal injuries, as well as in the craniocerebral group, major neurosurgical intervention should not be undertaken until loss of blood has been corrected and other thoracic or abdominal injuries of more immediate priority have been dealt with.
White JC. CARE OF THE SEVERELY INJURED PATIENT—NEUROSURGICAL INJURIES. JAMA. 1957;165(15):1924–1930. doi:10.1001/jama.1957.02980330026007
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