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A tiered approach to the treatment of head trauma
Treatment strategies for dogs and cats with head injuries should be directed toward both systemic and neurologic stabilization in an effort to minimize further damage. Several aspects of treatment exist. Systemic stabilization involves correction of systemic shock and respiratory abnormalities with fluid therapy and oxygen therapy/management of ventilation respectively. This is without doubt the most important aspect of head trauma management in any patient given that major causes of death in people with head injury include systemic hypotension and hypoxaemia.
Systemic stabilization should be immediately undertaken regardless of the neurological dysfunction which is noted when the patient presents (Fig 1, p. 18). The second aspect of treatment involves measures to reduce elevations in intracranial pressure and cerebral metabolic rate. Finally, some animals require surgical intervention because of lack of improvement or a declining neurologic status. Although once used as a treatment following head trauma, corticosteroids are no longer recommended in head trauma patients. Their use has been extensively evaluated in people and has shown no beneficial effect and may even result in worse morbidity and mortality rates.
Treatment of head trauma can be undertaken in a progressive tiered system based on the severity of injury and the success of the initial therapy. Tier 1 treatments are administered to all patients upon admission regardless of their injury severity. This tier of therapy is given to effect and so the least affected patients may not require extensive and or aggressive therapy; tier 2 treatments are administered to all patients with pupil size changes, and or marked depression of consciousness after Tier 1 treatment (Fig 2), tier 3 treatments are administered to all patients with pupil size and or light reflex abnormalities as well as a marked level of depression or loss of consciousness after ...
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