The treatment of craniocerebral injuries and prevention of anoxia.

Even mild head injuries may cause cerebral swelling and vascular alterations, including vasoparalysis and increased vascular permeability. The severer the injury, the more pronounced these changes. They may cause death. Maintenance of adequate oxygen supply to the brain is the most effectual means of preventing or reducing the severity of this secondary effect of cerebral trauma, and the preservation of a good respiratory exchange is therefore essential in a patient who is comatose as a result of a head injury. The commonly employed measures such as an oral airway, suction and oxygen therapy may be tried first, but if the patient continues to have respiratory distress or cyanosis, an intratracheal tube should be employed for 24 hours; and then if there is no improvement, tracheotomy should be carried out. If the injury is severe, tracheotomy from the beginning may be a life-saving measure.