Traumatic brain injury (TBI) is the leading cause of death among the young, and has an increasing incidence among the elderly. In Sweden there are 20 000 new TBI cases each year, of which most are mild. The primary impact can lead to different types of brain hemorrhages, fractures and diffuse axonal injuries. The level of consciousness is used to define injury severity. Of all TBIs,  4-5 percent require surgical intervention. The primary impact initiates injury processes exacerbating the initial brain injury, and the goal of the acute management and neurointensive care treatment is to prevent these secondary insults. Among unconscious TBI patients, monitoring of intracranial pressure and cerebral perfusion pressure (CPP, defined as the difference between the mean arterial pressure and intracranial pressure) is routine. In this article we present an overview on different types of TBI, and describe the treatment of patients in the acute setting.

De flesta är ense om att:

handläggning ska sträva efter att nå normala fysiologiska förhållanden

tidig administrering av tranexamsyra minskar mortaliteten

steroider och hypotermibehandling inte har en roll ihandläggningen

effekten av blodförtunnande behandling ska reverseras.

Åsikterna går isär vad gäller:

val mellan hyperton koksaltlösning och mannitol vidförhöjt intrakraniellt tryck

val av bedömningsskala för medvetandegrad.