A strategy to minimize secondary brain injury in head-injured patients is
a. hyperventilation to keep PCO2 less than 30.
b. fluid restriction to keep central venous pressure less than 6 cm H2O.
c. maintaining body temperature more than 37.5° C.
d. fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg.
D
Secondary injury can be caused by ischemia, hypercapnia, hypotension, cerebral edema, sustained hypertension, calcium toxicity, or metabolic derangements. Hypoxia or hypotension, the best known culprits for secondary injury, typically are the result of extracranial trauma. Extreme vasodilation of the cerebral vasculature occurs in an attempt to supply oxygen to the cerebral tissue. This increase in blood volume increases intracranial volume and raises intracranial pressure.
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