Analysis of therapeutic modalities for head-injured children.

The various stages and therapeutic modalities in the management of children with moderate and severe head injuries is reviewed. Emphasis on aggressive management upon arrival to the emergency room, and continuing until brain swelling has definitely resolved, is stressed. Management includes prompt endotracheal intubation and hyperventilation, arterial and venous lines and bladder catheter insertion. Computed tomography to assess underlying pathology, intracranial pressure monitoring for appropriate therapy should follow. In this way mannitol, other diuretics, hypothermia and barbiturate coma can be decided on, and the response assessed. The role of high dose steroids is discussed.