Road traffic accidents (RTA) are a leading cause of head /Brain injury and brain injury is the leading
cause of death in RTA. Other causes of head injury include falls from height, falling heavy objects on
the head, and assault. Early treatment is crucial to prevent secondary brain damage. The first hour is
the Golden Hour where aggressive treatment can save the brain from lasting damage, which means
the treatment should be started from the time the patient is transported from the accident site. The
main steps include- A. keep the airway clean from saliva, food particles, and vomitus. B. control
bleeding, C. maintain blood pressure and circulation

Severe head injuries with failing consciousness are managed in ICU preferably on ventilator for a
couple of days.

CT Scan of the brain demonstrates the presence of haematoma, extent of brain contusion, displaced
skull fracture and urgency for performing surgery.

Conditions requiring immediate surgery :-

1. Extensive scalp laceration :- This can lead to significant blood loss and hypotension.

2. Penetrating injury and depressed fracture of the skull :- Such injuries carry a high risk of
infection in the brain and hence need early attention.

3. Extradural Haematoma :- This is usually caused by a skull fracture injuring an underlying
artery of the dura mater. This leads to rapid accumulation of blood clots, leading to acute
compression of the brain, alteration of consciousness, and possible paralysis of limbs and coma. This life threatening condition needs evacuation of blood clots by ultra-urgent surgery. The results are very gratifying if performed in time. The patient who otherwise would have lost his/her life gains consciousness within hours

4. Brain contusion and Acute Subdural Haematoma :- Severe injuries to the brain lead to
contusion, laceration and accumulation of blood clots on the surface of the brain under the dura mater called subdural haematoma. This results in increase in intracranial pressure and rapid deterioration in consciousness or coma. The treatment is started to reduce intracranial pressure often by ventilatory support while some requiring immediate surgical intervention. In this surgery, a large portion of the skull is lifted off and the dura mater is opened widely to allow the swollen brain to bulge outwards thus relieving the compressive effect from the brain stem. Results of this surgery are also gratifying provided the procedure is completed in time before any irreversible damage to the brain stem could take place.