Consult neurosurgery immediately for EDH evacuation and repair. Consult trauma surgery for other life-threatening injuries. Etomidate, when used as RSI sedating agent, maintains SBP, lowers ICP and brain metabolism, and has rapid onset and brief duration. Thiopental is not recommended because of its propensity to drop SBP, which is the leading cause of secondary brain injury. Mannitol osmotically reduces ICP and improves blood flow.
Phenytoin provides prophylaxis against early posttraumatic seizure.
Osmotic diuretic - Osmotically reduces brain edema and ICP and reduces blood viscosity, improving cerebral blood flow and oxygen delivery. Antiepileptic - Prevents early posttraumatic seizure, which can increase ICP and neurotransmitter release as well as alter blood pressure and oxygen delivery. May be supplanted by fosphenytoin. If actively seizing, coadminister benzodiazepine. Admit to neurosurgical ICU after surgery or directly for monitoring.