![]() ![]() ![]() Initial medical treatment includes intravenous mannitol 20% or hypertonic saline (cerebral decongestant) and sedation. Ensuring head end elevation, proper neck position, patent endotracheal tube and urinary catheters, and intracranial hematoma must be ruled out before initiating treatment for elevated ICP. Clinical monitoring (with GCS-P) and CT findings are reliable measures to initiate the treatment for elevated ICP 24). BTF recommends seizure prophylaxis with Phenytoin to prevent early post-traumatic seizures 23). Preferred medication should have a rapid onset and offset, predictable pharmacokinetics with minimal alteration in cerebral metabolism and intracranial pressure 22). Sedation and analgesia are the initial steps to relieve the anxiety and pain in these patients, which in turn will help decrease the ICP. The neuro-critical care of traumatic brain injury patients carries a considerable value in initial management, especially in the golden hour. We try to understand the scope and implications of the concept of "Golden Hour" or "Golden sixty minutes" about imparting neurotrauma-related critical care. In literature, it is widely acknowledged that early management intervention can help to improve outcomes in a spectrum of disorders and disease conditions 7). This sequence of events is influenced by the "golden hour" concept and thus tries to reduce the injury to definite intervention times to the least 3, 5, 6). In trauma care, more so in neurotrauma care (more specifically in traumatic brain injury cases), the concept of the first 60 minutes or "golden hour" has been crucial as it determines the entire framework of trauma care which include pre-hospital care, patient transport, emergency room management and subsequent management protocols. The concept of the "golden hour" is widely reported in the management of trauma victims and the current trauma system concepts are primarily based on this concept of the "golden hour" 3). If the patient can get the desired or recommended interventions during this period, these will increase the chances of improved outcomes 3, 4). Adam Cowley coined the term "golden hour", which denotes the first 60 minutes after a patient sustains traumatic injury in the early 1980s (in broader perspective, any critical event related to health) 1, 2). Keywords: Traumatic brain injury Emergency Secondary damage Intracranial hypertension Hypothermia. In the present review, we attempt to draw attention to the importance of golden hour and emphasize that team-building and quality improvement are crucial to providing better outcomes. The advances in the diagnostic modality and the faster means of transportation have been a major driving force in decreasing mortality during the early hours following the incident. Training individuals about basic life support is the first challenge to delivering care at the scene of an accident/ or event or during transport. The major challenge in applying intervention during the golden hour is correctly identifying the correctable step in the victim at the earliest. If not timely addressed, these essential steps carry a maximum threat to the victim’s life by causing irreversible damage to vital organs. During these golden sixty minutes, the health care providers must focus on eliminating or mitigating the effect of critical events. The concept of a golden hour was probably derived from the French Military’s World war I data for the care of trauma victims, but it is suitable for all types of acute emergencies. The golden hour is the time following an injury during which appropriate medical attention carries the highest likelihood of a better outcome.
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