Combined traumatic brain injury
Traumatology / / August 12, 2017
Traumatic brain injury in the structure of associated injuries is leading both in frequency (46.9% of all patients with combined injuries), and severity.Brain injury is the result of traffic accidents (58.7%), falls (37%), falls on the street (3%), and blows to the head (1.3%).At the time of the injury 33% of patients (mainly men) are in a state of alcoholic intoxication.Skull fractures occur in 56.5% of the victims, closed - 44% open - at 12,1%, is dominated by fractures of the cranial vault (27.7%), then - the roof and the base (15.8%) and base (13%).Damage to the facial skeleton observed in 28.1% of patients (often - lower jaw, nose, bones, upper jaw, at least - the zygomatic bone).
Signs and symptoms of a traumatic brain injury
diagnosis of a fracture of the cranial vault is placed on the basis of external characteristics (deformation arch area, palpation of the indentation and an emergence of fragments, an open fracture).The symptoms of basilar skull fracture include: bleeding in the eyelids ( "
clinical picture of brain states in the majority of cases the symptoms associated obscured more serious injuries (fractures of the ribs, pelvis, extremities).It is believed that the serious injury resulting from traffic accidents, as well as a fall from a height, regardless of the localization of the damage to be expected of a brain injury (concussion often).
The clinical picture distinguish the following degrees of concussion:
mild degree (without sharply expressed focal symptoms, a brief loss of consciousness, the presence of a fracture of the cranial vault);
moderate severity (with marked focal symptoms - hemiparesis, paralysis, convulsions with loss of consciousness or soporous state for several minutes or even hours);
severe (with multiple diffuse symptoms, meningeal symptoms, secondary tabloid disorders: respiratory disorders, swallowing, cardiovascular activity, as well as the presence of a coma or long somnolence state for several weeks).
Brain Injuries, usually accompanied by severe fractures of the skull base and constantly serve as a major drag on the active orthopedic treatment of fractures of limbs, even when head injury is not dominated by the severity of clinical picture of the victims.It is believed that in some cases, expectant management ( "to ascertain the trend towards improvement") in relation to the accompanying severe limb damage few substantiated, bringing the condition of the victims may deteriorate due to the second developing injury complications: toxicity, anemia, infections, and so on.g., which in themselves active preclude surgical intervention.
diagnosis of irreversible brain injury in polytrauma extremely difficult and largely determined at autopsy.The most important symptoms, allowing the background of general Multiple injuries reveal brain destruction are deep coma, severe respiratory distress, drop in blood pressure, pulmonary edema, arefleksiya maximally dilated pupils without their reaction to light, hypothermia, bioelectric "silence" of the brain.Topical diagnosis of contusion, hemorrhagic foci in brain injuries using clinical methods when combined injuries difficult due to damage to the peripheral nerves, polifraktur extremities, pelvis and spine.
- Treatment of combined traumatic brain injury
- damage the spinal cord and cauda equina
- Combined and multiple trauma of the spine
- Trauma skull for fractures of the spine
First Aidin traumatic brain injury
exposed person with symptoms of concussion provide physical and mental rest, laid with a raised head, undo the gate, cooled his forehead with a wet towel.Transportation is carried out strictly on a stretcher to the surgery, trauma or a neurological department.
When brain injuries are focusing on the fight against acute respiratory failure.To this end, restore patency of the upper airway, give birth to the duct, carry oxygen inhalation, if necessary, the victim is intubated and artificial lung ventilation is performed manual respirators or portable machines.Prevention
CSF hypertension carried intravenous 40% glucose solution (40 to 60 ml), urea (20% solution of 100-150 mL), mannitol (300-400 ml 20% solution), Lasix (1.2 ml), novocaine(300-400 ml of 0.25% solution).When administered intramuscularly hyperthermic response aminopyrine (4% solution 5.10 mL), intravenously - analgin (2 ml of 50% solution), diphenhydramine (1 ml of 1% solution).Head cooled ice packs, wet towels.With symptoms of severe shock infuzibnnuyu conduct intensive therapy: intravenously infused 400 ml polyglucin (zhelatinol), 500 ml of a 10% solution of glucose + insulin (12 IU), glyukozonovokainovuyu mixture (1000 ml drip).Also introduced to 0.5 g of hydrocortisone sodium oxybutyrate 80-100 ml 20% solution per day.Affected are transported in a horizontal position with the head elevated.