Victorian State Trauma System

Major Trauma Guidelines & Education – Victorian State Trauma System

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Early management of head injury is directed at minimising any secondary brain injury by avoiding periods of hypoxia and hypotension. It is not about complex, specialist care but about applying basic principles in support of the injured brain.

Key Messages

The Victorian State Trauma System (VSTS) provides support and retrieval services for critically ill trauma patients requiring definitive care, transfer, and management.

This traumatic brain injury guideline provides evidence-based advice on the initial management and transfer of major trauma patients who present to Victorian health services with severe traumatic brain injuries.

This guideline is developed for all clinical staff involved in the care of trauma patients throughout Victoria. It is intended for use by frontline clinical staff that provide care for major trauma patients; those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS.

This guideline provides the user with accessible resources to provide appropriate care effectively and confidently for critically injured patients. This provides up-to-date information for frontline healthcare clinicians. The guideline has followed the AGREE II methodology for guideline development and is under the auspice of the Trauma System Advisory Committee (TSAC) (1).


Clinical emphasis points

  • Traumatic brain injury is a significant cause of morbidity and mortality in Australia.
  • Primary and secondary insults can result in significant injury and early management to prevent further brain injury must begin at the scene.
  • Minimising secondary brain injury is best achieved by avoiding periods of hypoxia and hypotension. Maintaining adequate oxygenation, ventilation and cerebral perfusion is essential.
  • Once it is identified that the patient has suffered traumatic brain injury, early activation of the retrieval process is crucial.
  • Timely transfer to definitive care at a specialist neurosurgical center is often crucial and ultimately can have a considerable influence on patient outcome.
Avoidance of hypoxia and hypotension is essential