Our experts in the field of neurosurgery and maxillofacial surgery at
international conferences, to put it mildly, "surprise" of foreign colleagues
statistics for injuries received as a result of fierce Russians
fights. Patients are "foreign" doctors - it's mostly the victims
industrial and road cases. Why is it so high level
aggression in us and what threatens human "innocent" concussion,
obtained by clarifying the relationship, or for any other reason? what
you need to know and what to do if the head injury occurred yet?
This was and how dangerous such an injury, tell
Associate Professor, Department of Traumatology of the Russian Medical Academy
Postgraduate Education Nikolai Nikitich Shipkov and Eugene S.
Signs of trauma
The peculiarity of the modern trauma is absolutely high
mortality at a young age. Even among patients with surgical
Profile at a fraction of trauma patients account for more than 50%.
Among the traumatic brain injury (TBI) is isolated:
- Concussion without degrees.
- Brain Contusion three grades (mild, moderate, severe).
- Traumatic intracranial hemorrhage.
Combined damage to the skull and brain:
- bruises and injuries of the skull soft tissue injury to the brain, meninges and blood vessels;
- closed skull fracture with brain injury (contusion, concussion), with damage to the meninges and blood vessels;
- bone fracture of the skull base with damage to the brain, membranes, vessels and cranial nerves.
Damage to the brain stem without clinical manifestations.
Bruises are different
Among the common injuries can be called brain injuries,
which vary in severity (mild, moderate, severe)
location and depth of damage. Lesions of brain tissue
may be in the cerebral hemispheres on the surface thereof,
basis, in the cerebellum and brainstem sections. Of course, the diagnosis - a case
doctor, but on what grounds it can be determined what kind of damage
a person, especially if he refuses or is in no hurry to apply for
Injuries of the surface layer of gray matter of the cerebral hemispheres (cortex) of the brain relate
to mild injuries. Loss of consciousness in these patients continues
up to three hours, then a few days stunning observed. pupils at
human evenly narrowed, photoreaction born alive. The victim
occasionally nausea, retching marked.
Brain injury secondary degree accompanied by damage
brain tissue the deeper layers beneath the crust. In that
the case of loss of consciousness may last 2-3 days. pupillary reaction to light
sluggish. Quite often there are convulsions.
Injuries severe accompanied by extensive
hemorrhages. In this case extends unconsciousness
up to two weeks. The photoreaction in the bad light, seizures are frequent and
duration. There have been gross violations of breathing, swallowing,
cardiovascular activity, urinary incontinence and
passage of stool. Gross violations of consciousness of patients with brain injuries
Brain moderate and severe associated with damage to the brain stem.
It occupies a special place squeezing head. is observed
earthquakes, destruction of houses, industrial buildings, falling from
the height of the head, transport accidents (air, rail,
automotive). Kinetic energy can literally split the head,
like a nut! Traumatizing the soft tissue of the head, broken bones.
In yet another frequent injury - brain concussion -
observed brief loss of consciousness, amnesia, retrograde
(Loss of memory), the lungs rapidly reversible cerebral symptoms.
Injuries often leave clear traces, and it is important to pay
attention. Diagnosis of brain injury and skull built
based on availability, assess the "combat" injury marks. These include:
swelling, wound scalp, BTE areas bruises soft
tissue and, of course, hematomas (bruises), their layout and the magnification.
Critical Accounting Estimates "traces" bleeding from the nose, ears and of their time
appearance. It is mandatory to be considered violations levels
consciousness (clear mind, stunning, different degrees of coma).
For example, the so-called "symptom score" (formed under the eyes
bruises in the form of points) indicates a fracture of the skull base in
the anterior cranial fossa. But doctors should exercise 'gematomnuyu
alertness ". Bright demo, you will immediately see "a symptom
points "can exist without fracture, and be the result of
descending hematoma with the frontal area.
Alexander Pushkin in 1830, wrote a beautiful fairy tale "About
Priest and His Workman Balda ". If you remember only a small its
fragment, where the calculation of the final between pop and Balda, here with
clearly we can see the seriousness of a head injury,
brain and its consequences.
"Poor pop Framed forehead: the first pop lye jumped to the ceiling;
from the second lye lost pop language, and the third slot knocked in mind
old man. " Here, in all its glory before us the clinical picture
injury. There was the first direct contact, and as a result
short-term, but over-applied force people jumped
pain reaction. The second click summoned speech disorder ( "lost language"),
but the third strike "blew the mind of the old man" - came amnesia, perhaps -
Impaired consciousness (stunning, stupor, coma) leads to disruption
speech ( "verbal hash", or mumbling complete lack of speech). at
amnesia, memory impairment occurs (the person can not remember,
save, play). In various cases, the victim does not remember,
what happened during the traumatic brain injury, does not remember what happened after the exit
state of impaired consciousness, does not remember what it was before the injury, may
did not receive the information.
As can be seen, head injury - it's always serious. Therefore, each
I should know and be able to provide first aid to the victim. when all
types of severe brain injury must be made radiographs
cervical spine in order to avoid additional and
possible concomitant injuries (fractures, fracture-dislocations).
Normalization of the changes happening in terms of 1-14 days, and
ultrastructural changes in the nervous system can be observed in
within 1-4 months and be a source of post-traumatic syndromes
traumatic brain disease.
Lie down, and no nails!
Further treatment prescribed by a doctor. Strict bed rest
for up to 1 week. Strict bed rest - is the cornerstone
treatment, "trunk", which "hang" drugs.
Masta wards here and there, engage in this nonsense, play cards and
dominoes with neighbors, to talk over and over not to be.
The victim should be quiet as a mouse. Excessive activity,
reading newspapers, magazines, watching television, especially sports
(Football, boxing) - only harm. All loads are not shown, and
contraindicated. Required medication. After
extracts recommend limiting physical, mental loads
within a month.
Minimum terms of patient treatment in the acute period and the total duration of the following:
- in cerebral concussion - at least 2 weeks, temporary disability - not less than 4-5 weeks;
- with brain contusion mild - 3-4 weeks, and 1.5-2 months;
- in brain injury severe duration of up to 2-3 months or more.
According to the modern and generally accepted classification of concussion
brain relates to the severity of mild traumatic brain injury. but
question about the outcome of a concussion or brain injury is not decided before
than 3 months after the injury. This is due to the fact that
process is very dynamic and in one form of posttraumatic period
can go to another, qualitatively more severe, and serve
basis for the definition of permanent disability. therefore
related to "light" injury must be very serious.
Instruction provided by several
It is necessary to clarify the circumstances of the injury to the patient (if he
conscious) or from eyewitnesses. Proceed as follows:
- The patient should be put in a horizontal position, unbuckle
collar, loosen the belt, to assess the severity of the condition, the pulse frequency
- Loosen the upper airway from blood, mucus, foreign
bodies, broken teeth, dentures using the index finger,
wrapped in wet bandages, gauze.
- Perform artificial respiration means "mouth to mouth" or "mouth-to-nose". When massive bleeding from the wounds of the head must be
stop the bleeding by pressing on the bleeding vessel
Over the period of double bleeding time (8-10 minutes), to impose
soft bandage, call the machine "emergency" for
transportation to the hospital.
- sterile dressing is applied If the damage eyes (you can
use of clean cloth and the pressed sheets, shirts).
Flush the affected eye should not be. Exceptions are
eye burns which require copious washing with water.
- When bleeding from the ear hole is necessary to lay a piece of cotton,
bandage or gauze (pad to enter deeply impossible because of the danger
infection). At the turn of the bones of the nose of the patient is placed with
elevated headboard, is applied to the bridge of ice pack or
ice pieces, placed in a plastic bag. Fractures of the bones of the nose
always accompanied by bleeding. In this case, the strip is introduced into the nose
gauze bandage soaked in 3% hydrogen peroxide solution, or
impregnated with vaseline or any other oil. If the victim in
consciousness, it is necessary to ask him to spit blood, and do not swallow, so
as there may be vomiting.
- Fractures of the lower jaw are almost always accompanied by tears
mucous. It is recommended to rinse the mouth with a weak solution of permanganate
potassium (potassium permanganate). Any food banned before admission.
- Minor abrasions, superficial wounds treated alcoholic person
iodine solution or a solution of brilliant green (green stuff). Can
use sterile wipes and individual dressing package
- Patients with concomitant brain injury should be
transporting hard stretcher, fixed at the head of the board and
with padded neck roll for them or rubber ring. The head should
It is turned to the side to avoid the possibility of choking.
What not to do: remove bone fragments, foreign bodies from the wound,
reduce a dislocation or fracture, deep dab ear passages,
poorly or insufficiently cleaned the upper respiratory tract.