• Actively manage raised intracranial pressure.

• Actively treat seizures with anticonvulsants to prevent further hypoxaemic cerebral damage, reduce cerebral oxygen requirements and ICP. The patient should be loaded with IV phenytoin as prophylaxis against further fits. Consider additional causes such as hypoglycaemia, development of a new space-occupying lesion, recreational drugs and infection.

• Diabetes insipidus suggests hypothalamic injury and carries a poor prognosis. Desmopressin 1-4pg IV should be given daily to maintain urine output of 100-150ml/h.

Actively manage hyperpyrexia. Some studies show long-term benefit from induced hypothermia but this needs to be aggressively instituted as early as possible after the injury to be effective.

• Actively manage hyperglycaemia with insulin, and avoid hypoglycaemia.


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