Management of acute-stage head trauma in childhood

Trauma victims are directly transferred to a level I trauma center bypassing local hospitals. First, airways and cervical stability are secured. Intracranial hematoma should be promptly evacuated. Endotracheal intubation and mechanical ventilation are initiated for children with a Glasgow Coma Score of 10 or less, anisocoria, apnea, and/or hypercarbia. Isotonic crystalloid is used for intravenous fluid maintenance. The goal of intracranial pressure (ICP) management is to maintain the ICP at less than 15 mmHg and to maintain minimum cerebral perfusion pressure at 45~55 mmHg. External ventricular drainage provides direct control of the ICP by allowing intermittent drainage of the CSF (5~10 ml/hour). Mannitol is effective but hyperventilation is not recommended.