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The Neglected Prehospital Phase of Head Injury: Apnea and Catecholamine Surge

  • John L.D. Atkinson
    Correspondence
    Address reprint requests and correspondence to John L. D. Atkinson, MD, Department of Neurologic Surgery, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905
    Affiliations
    Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minn.
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      The prehospital phase of head injury, also called the critical phase, consists of trauma-induced apnea and stress catecholamine release. This immediate period after head injury remains poorly summarized in the literature and essentially ignored with respect to treatment. A MEDLINE search of the literature on apneustic response and catecholamine surge after head injury and a review of literature from my acquired references revealed 116 references (from more than 600) that were pertinent. Apnea induced by head injury produces hypoxia, hypercarbia, and subsequent cardiac failure and hypotension, which, along with substantially bstantially elevated catecholamine values, promote secondary mechanisms of organ injury. Treatment for this immediate period after head injury requires a rapid response to the scene of trauma and development of treatment options that can be instituted at the scene of injury.
      EMS ( emergency medical service), ICP ( intracranial pressure), NPE ( neurogenic pulmonary edema)
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