First emergency care in traumatic brain injury
The urgency of treatment and diagnosis of traumatic brain injury in our time is not in doubt: the deterioration of living conditions, unemployment, rising crime, drug crime increased injuries.Due to the increased consumption of alcohol and drugs, their frequent overdoses (drug coma) has become more difficult to differentiate a head injury in a coma;In addition, the lack of modern diagnostic equipment hospitals as this does not contribute, therefore, becoming increasingly important to a thorough medical history, patient survey.At the core of brain tissue damage when head injuries are primarily mechanical factors: compression, tension and displacement.Offset medulla may be accompanied by rupture of blood vessels, brain contusion of the skull bones.These are supplemented by mechanical disturbances complex biochemical disturbances in the brain.
Head injuries are divided into indoor and outdoor (penetrating and non-penetrating).
Closed injury is divided into a concussion, contusion and compression.Related t
Concussion is characterized by a triad of symptoms: fainting, nausea or vomiting, retrograde amnesia;no focal neurological symptoms.
brain contusion diagnosed in those cases in which the cerebral symptoms are supplemented by signs of focal brain lesions.There are contusion mild, moderate, severe.
Bruising is characterized by mild off of consciousness after an injury from a few minutes to 1 hour.After regaining consciousness impose complaints of headache, dizziness, nausea, repeated vomiting.Celebrating retro and antegrade amnesia, iethe patient does not remember anything before and after the injury.Neurological symptoms expressed mild, it is the asymmetry of the limbs reflexes, nystagmus, which gradually disappear in 2-3 weeks after the injury.
moderate contusion of the brain characterized by loss of consciousness for a period of several minutes to 4-6 hours. Note the pronounced effects of amnesia (retro and antegrade).Complaints of headaches, repeated vomiting.There are transient disorders of vital organs: bradi- or tachycardia, shortness of breath, fever up subfebrile.In the neurological status mark a distinct focal symptoms, depending on the localization of contusion foci;paresis of the extremities, sensitivity disorder, speech disorder, pupillary and oculomotor disorders, meningeal symptoms, and others who are gradually beginning to flatten by 3-5 week after the injury for a long time.
brain contusion is characterized by severe loss of consciousness for a period of several hours to several weeks, during which a marked motor excitation.There are serious violations of the vital functions: increased blood pressure, tachycardia or bradi-, violation of breathing rate and rhythm, until the abnormal breathing.Expressed hyperthermia.The neurological symptoms are often dominated by a primary lesion of the brain stem (floating movement of the eyeballs, paresis gaze, swallowing disorder, Babinski reflex).Sometimes noted seizures.All these symptoms regress slowly, for months and years on the background of pronounced mental disorders.
compression of the brain can be caused by intracranial hematoma, depressed fractures, leading to brain injury.For the compression of the brain most often characterized by the presence of the "bright period", which in severe brain damage can not be.Compression of the brain develops in the injury of varying severity.It is characterized by life-threatening increase of brain symptoms (increased headache, repeated vomiting, agitation, etc.);focal symptoms (the appearance and growth of limb paresis or hemiparesis up to paralysis, disturbance of sensitivity, etc.), the advent of stem symptoms (occurrence or deepening bradycardia, respiratory disorders or swallowing).One of the pathological symptoms, usually indicating the presence of an intracranial hematoma is a sharp increase on the side of the pupil hematoma (anisocoria) and the occurrence of epileptic seizures.It should be remembered that the degree of severity of traumatic brain injury does not always coincide with the severity of the victim status, since the latter may be due to severe cumulative damage, which leads, in addition to the impairment of consciousness and focal neurological disorders, which are the criteria the severity of the brain injury, to violations of the vital functions of the body.
Emergency care .All the victims with a closed head injury be hospitalized on a stretcher in the neurosurgical department.If the brain concussion and contusion mild enter analginum 50% strength solution of 2 ml + dimedrol solution 1% - 1 ml.
When brain injury of moderate and severe, if the patient is unconscious, you should put it on the back, clean the mouth and throat of mucus, blood and other foreign bodies;Ambu bag ventilation is performed or the machine type KI-ZM;or "mouth to mouth".Intravenously administered 40-60 ml of 40% glucose and 40 ml of Lasix (unless low blood pressure).Or intravenously administered solutions of GHB (10-20 ml) or relanium (10-20 ml), to prevent seizures.By a 40% glucose added to 10-20 ml piracetam (DOE-Tropez).
If low blood pressure, begin infusion polyglucin (400 ml, 60-90 mg of prednisolone), Lasix can not be entered with low blood pressure.Nor can it be administered morphine omnopon, camphor, as they raise intracranial pressure.The horn is introduced duct and without stopping the infusion, the patient is transported.