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5. Medical ComplicationsIn addition to the preceding neurogical complications, the recovery of a patient with severe head injury is adversely influenced by medical complications. The most frequent medical complications include disturbances of serum electrolytes, particulary serum sodium, which occurs in as many as 60% of patients, and pneumonia, which occurs in as many as 40% of patients, with aspiration pneumonia being the most frequently occuring. Endotracheal intubation protects the airway best against large particles entering the bronchial tree; gastric fluids still pose a risk to he patient. Hypotension occurs commonly in both the prehospital and inpatient setting (22%) and may cause secondary brain injury. Coagulopathies (18%) and septicemia (10%) are less common complications of severe head injury. Cardiac dysrythmias occur more often in patients with subarachnoid hemorrhage and may mimic a cardiac contusion on electrocardiogram. Gastrointestinal bleeding is less common than in the past, in part due to heightened awareness and vigorous prophylactic treatment.Septicemia, nosocomial pneumonia, coagulopathy, and hypotension are associated with increased morbidity and mortality. Prevention or effective treatment of these major and frequent extracranial complicationns following severe head injury could reduce morbidity and mortality in this group of patients.
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