Closed cranopy and brain injury (ZCHMT) - damage to the head in which the integrity is preserved connective tissue Under the scalp (occipital aponeurosis) covering the entire skull. Skin covers can be oversight. The consequences of a closed cranial injury in the future depends on the intensity of the damaging factor, as well as on which formation of the central nervous system damaged.

Classification of closed cranial injury

The closed cranial trauma has a cipher on the ICD-10 S00-T98. There are several types of consequences, various gravity and symptoms:

1. With closed brain injury.
2. Traumatic swelling.
3. Injuries: diffuse, focal.
4. Hemorrhage: epidural, subdural, subarachnoidal.
5. Coma.

Symptoms

Signs of closed cranial injury include a violation of consciousness, a change in reflexes, memory loss (amnesia). The victim can be in consciousness, and without him. The main symptoms of a closed cranial injury:

1. Stunning, stupor, loss of consciousness.
2. Incoherent speech.
3. Nausea, vomiting.
4. Excited or inhibited state.
5. Violation of a sense of equilibrium.
6. Cramps.
7. Loss of reaction of pupils into light.
8. Disturbance of swallowing, breathing.
9. Circles around the eyes (symptom of glasses).
10. Reduced arterial pressure (sign of damage to the bulbar department).

The unconscious or stunned state is a characteristic SCMT symptom caused by the death of nerve cells. The victim can be excited, aggressive or inhibited and not react to stimuli.

It gives severe pain, nausea, vomiting, in which the contents of the stomach can be hit in the respiratory tract. As a result, asphyxia (choking) is possible or aspiration pneumonia. With an increase in intracranial pressure, convulsive syndrome often develops.

When a patient has a shaky gait, trembling eye apples. Damage to the vessels with severe injury causes the formation of a large hematoma that gives rise to the formation of the central nervous system.

The swallowing disrupting develops under the damage to the stem department, in which the cores of the cranial nerves are located. Memory loss - frequent symptom of brain damage. However, it can and restore in some cases.

Vegetative manifestations are possible, such as excessive sweating, violation of cardiac activity, redness or pacelas. Reduced blood pressure - a sign of damage to the pressing department of the oblong brain. The displacement of the tissue of the brain (dislocation syndrome) is manifested in various pupils.

Emergency care with closed brain injury

It is necessary to deliver a person to a medical facility as soon as possible, not allowing a strong shaking during transportation. In vomiting, in combination with an unconscious state, it is necessary to put the patient so that the head is turned on the side and the lots of mass fluidly flow through the mouth, without falling into the respiratory tract.

Diagnostics

The victim is necessary to inspect a neuropathologist and traumatologist. Feldsher ambulance should interview witnesses about the incident. With shocks and brain bruises, they check the reaction of pupils into light, as well as its symmetry. Test tendons and other reflexes.

To diagnose damage use ultrasound procedure, magnetic resonance tomography, and sometimes radiography and CT. When comatic condition, the severity in the scores on the Glasgow scale is evaluated. A general blood test is also carried out, a coagulogram, a biochemical blood test from the finger on glucose.

Treatment of closed cranial injury

Treatment of patients with closed traumatic lesions of the head depends on the severity of damage, the health status of the patient. After diagnosing damage, the following comprehensive measures are used:

1. At the edema of the brain and elevated intracranial pressure prescribed dehydration therapy. Digestive means (furosemid, mannitis) eliminate the edema of the brain, which provokes convulsive seizures.
2. At headaches are prescribed analgesics.
3. To reduce intracranial pressure and improve the venous outflow, the patient's head is raised above the body level.
4. Salted products are excluded from the diet.
5. In case of conservation convulsive syndrome It is stopped by anti-wurals.
6. If the dumping masses occurred in the respiratory tract, they are aspiration using a pump.
7. Breathing disorder requires intubation. At the same time, all important life indicators are monitored: oxygen saturation level, heart rate.
8. If the swallowing function is broken, the patient is powered by a nasogastric probe.
9. If there is a hematoma, threatening the brothering of the brain barrel, is removed by operation with the trepanitation of the skull.
10. Antibacterial agents are used to treat infection (, encephalitis).
11. Eliminate the consequences of a closed cranial injury. Again antihypoxic agents: Mexidol, cytooflavin, cerebrolysin.
12. Recommend acupuncture. The procedure will help with residual paralysis.
13. RANC is prescribed - the method of restoring the activity of brain centers, which improves the condition of patients in a coma.

To mitigate residual phenomena, rehabilitation is necessary: \u200b\u200blearning oral speech, writing, practical skills. Memory recovery occurs with the help of relatives and loved ones. To eliminate the disorder of microcirculation and memory recovery, nootropic drugs are used: piracetam, nootropyl, cavinton, stamp brain circulation, weaken the syndrome intracranial hypertension.

Conclusion

Closed head damage has various severity. Easy degree can pass unnoticed for the victim, but it does not cancel the treatment of a traumatologist. The affected necessarily needs to make a radiological examination of the head. With severe lesions, a comatose state is developing, threatening life, especially in the presence of dislocation syndrome.

Classification of the cranial injury -.

code for insertion on the forum:

Classification of the cranial injury on the ICD-10

S06 intracranial injury

Note: With the primary statistical development of intracranial injuries, combined with fractures, it is necessary to be guided by the rules and instructions for encoding the incidence and mortality set forth in part 2.

• S06.0 Brain concussion
• S06.1 Traumatic brain swelling
• S06.2 Diffuse brain injury
• S06.3 Heat brain focal injury
• S06.4 Epidural hemorrhage
• S06.5 Traumatic subdural hemorrhage
• S06.6 Traumatic subarachnoid hemorrhage
• S06.7 intracranial injury with a long comatose
• S06.8 Other intracranial injuries
• S06.9 intracranial injury uncomputed

  Excluded: Head Injury BDU (S09.9)

S07 Head Discharge

• S07.0 Discharge facial
• S07.1 Spotchape scraps
• S07.8 Discharge of other parts of the head
• S07.9 Discharge of the unspecified part of the head

S08 Traumatic Ampute Parts Head

• S08.0 Out of the scalp
• S08.1 Traumatic ear amputation
• S08.8 Traumatic amputation of other parts of the head
• S08.9 Traumatic amputation of the unspecified part of the head

Exclosed: decapitation (S18)

Clinical classification of acute acute brain injury [Konovalov A.N. et al., 1992] *

• brain concussion;
• brain injury easy degree;
• middle-degree brain injury;
• injury brain injury;
• diffuse axonal brain damage;
• brain compression;
• head squeezing.

* Konovalov A.N., Vasin N.Ya., Lighterman L.B. and etc. Clinical classification acute acute brain injury // Classification of cranial injury. - M., 1992. - P. 28-49.

Investigation of damage to the bones of the skull in the experiment at dosage strikes / Gromov A.P., Antufyev I.I., Saltykova O.F., Skypnik V.G., Boltsov V.M., Balonkin G.S., Lemolas V.B. ., Maslov A.V., Velmkovich N.A., Krasnoyy I.G. // Forensic-medical examination. - 1967. - №3. - P. 14-20.

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Head injuries (S00-S09)

• eyes
• persons (any part)
• gums
• jaw
• area of \u200b\u200bthe temporomandibular joint
• oral cavities
• folk-eyed region
• misselting of the head
• language

The brain injury is quite a serious injury, in which the fracture of the skull bones can occur, there is a diffuse pronounced damage to the brain tissue, sometimes the bruised is complicated or hematoma. With this injury, persistent consequences are often developing. The mechanism for obtaining injury is similar to other traumatic lesions, the only difference is the power of the impact.

Information for doctors. On the ICD 10 there are no clear criteria for the diagnosis encoding, most often the cipher of the brain injury over the ICD 10 passes under the code S 06.2 (diffuse crank and brain injury), sometimes cipher S 06.7 (diffuse injury with a long comatose state) is used, it is possible to use a coding coding - S 06.0. When specifying the diagnosis, the fact of injury (open or closed) is made, then the main diagnosis - brain injury, indicates the degree of gravity (light, medium, heavy), internal hemorrhage, the presence of fractures of the bones of the skull (indicating specific structures). At the end, the severity of syndromes (cephalgic, vestibulo-coordinator disorders, cognitive and emotional-volitional disorders, depressive syndrome, asthenic syndrome, dissismini, etc.) is taken out.

Symptoms and signs

Symptoms vary depending on the severity, which is diagnosed just according to the data of the history, neurological inspection, the presence of certain complaints and their speakers against the background of treatment.

Severity

The bruise of the brain of the brain is a fairly frequent injury that needs to be distinguished by. At a given severity, the presence of a loss of consciousness for 5-15 minutes is characterized, the presence of nausea for quite a long time, almost always takes the place of vomiting to 2-4 times. From the total-selling symptoms there is moderate or severe headache, dizziness, sometimes developing reflex violations from the cardiovascular system. Diagnosed from about 15 percent of all victims of the cranial injury.

The injury of medium gravity brain is characterized by more pronounced manifestations. The loss of consciousness can be several hours, there is a fact of multiple vomiting. Promotional symptoms are expressed, which may be accompanied by emotionally volitional disorders, cognitive impairment. The patient may not be aware where he is located, amnesia sometimes develops. It often takes place the fracture of the bones of the skull and the corresponding symptoms (swelling, soreness, temperature increase). When hemorrhages, meningeal symptoms occur.

The injury of a severe brain is rarely found and is a serious state that is often completed with a fatal outcome when the assistance has not been revealed. The loss of consciousness can last for a long time (more than a day), the rude neurological insufficiency of all functions of the central nervous system develops. The severity of all symptoms is usually high, mental disorders are frequent. Often develops a life-threshing state due to the lesion of the vital centers (respiratory and vascular).

Diagnostics

Diagnosis is carried out, as mentioned above, on the data of the anamnesis, neurological status, the severity of complaints. However, sometimes it is difficult to differentiate concussion and injury. In this case, mandatory neurovalization methods of research (MRI, MSCT) can also help.

The fact of fracture, hemorrhages and other coarse disorders of the central nervous system structures speaks in favor of the brain's injury. Also, with this type of injury, a pronounced violation of neurological functions occurs. Nistagm, high degree of increasing tendon reflexes, pathological reflexes. Violations of the cranial nerves speak in favor of a more severe injury.

Treatment

Treatment is to maintain vital functions, surgery, destination conservative therapy. With severe degrees, the patient's injury must be delivered as soon as possible to the separation of intensive therapy, ensure the maintenance of the respiratory function, as well as control of cardiovascular indicators.

Surgical intervention is carried out with an open injury, displacement of bone fragments. Hematoma, foreign bodies in the wound are also surgically removed. When forming a block of outflow of the cranial-brain fluid, decompressive operations should be carried out.

Conservative therapy is carried out symptomatic, neurotropic means, cerebrovascular drugs. The patients are mandatory preventive therapy for the development of brain edema (the diakar is most often used in combination with potassium preparations), adequate anesthetic therapy is produced by non-steroidal anti-inflammatory agents (ketonal, voltaren, etc.).

Of specific neurotropic therapy, Actovegin, cytooflavin, mexidol, vitamins B, glatchilin and other drugs are most often used. If necessary, antidepressants and tranquilizers are appointed.

Effects

The consequences of this injury remain almost always and are characterized by a diagnostic term - post-traumatic encephalopathy. Patients reduced memory, attention, borrow headaches, dizziness. Sleeping sleep, mood, reduced performance. The treatment of this state is the regular passage of courses of neuroprotective, vasoactive, nootropic therapy.

Sometimes, in severe cases, there are early consequences - a block of circulation of the spinal fluid with sharply increasing hydrocephalus syndrome up to the death of the patient, if surgery will not be carried out in a timely manner.

Brain-brain injuries (MKB-10-S06.) We are divided into closed and open. To closed Ch.-M. t. relate to damage under which there is no disorder of the integrity of the cover of the head or there is damage to soft tissues without damaging the head aponeurosis. To open Ch.-M. t. These are cases with damage to soft tissues and aponeurosis; It can be imperminating (with the preservation of a solid cerebral shell) and penetrating with a violation of the integrity of a solid cerebral shell, as well as the fracture of the base of the skull.

Closed brain injury Severity is divided into easy, moderately and heavy.

Brain injury Middle severity is characterized by a disturbance of consciousness after injury from tens of minutes to 3-6 hours, the severity of retrograde and anterograd amnesia. Strong headache, multiple vomiting, bradycardia or tachycardia, tachipne, subfebrile body temperature are noted. Frequently observed shell symptoms. In neurological status, focal symptoms are expressed: pupil and ocean violations, parish limbs, sensitivity disorders and speech. Fractures of the bones of the arch and base of the skull are often found, significant subarachnoid hemorrhages. Computer tomography in most cases reveals focal changes in the form of small inclusions of increased density against the background of reduced density or moderately homogeneous increase in density, which corresponds to small-scale hemorrhages in the injury or moderate hemorrhagic hemorrhagic imgusting of the brain tissue.

Brain injury severely characterized by loss of consciousness for a long time, sometimes up to 2-3 weeks. Motor excitement is often expressed, severe respiratory rhythm disorders, pulse, arterial hypertension, hyperthermia, generalized or partial convulsive seizures. Characteristic neurological symptoms: floating movements of eyeballs, parishs of the gaze, nistagm, swallowing disorders, bilateral mydriasis or mios, changing muscle tone, decerebraction rigidity, depression of tendon reflexes, double-sided stop pathological reflexes, etc. Dummy impaired muscle tone, reflexes of oral automatism. Primary-stem symptoms in the first hours and days climbs focal half-hearted symptoms. General and especially focal symptoms disappears relatively slow. Permanent are fractures of the bones of the arch and base of the skull, massive subarachnoid hemorrhages. On the eye day there are stagnant phenomena, more pronounced on the side of the bruise. Computer tomography reveals a traumatic focus with hemorrhages and bundle of white brain substance.

Brain compression (MKB-10-S06.2) is manifested by increasing through different intervals after injury or immediately after it are common, focal and stem symptoms.

Intracerebral hematomas (MKB-10-S06.7) in children are rare, localized mainly in the white substance or coincide with the brain injury zone. The source of bleeding is mainly vessels of the medium cerebral artery system. With severe brain injury, V. G. is usually combined with epidural or subdural hematomas. V. G. are detected 12-24 hours after injury. They are characterized by the rapid development of the clinical picture, the rapid appearance of coarse focal symptoms in the form of hemiparesis or hemiplegia. Symptoms includes signs of the growing brain compression and local symptoms. On a computer tomogram is detected in the form of round or elongated zones of a homogeneous intensive increase in density with well-defined edges.

The consequences of CMT on ICD-10 have code T90.5. The brain injury is fixed in the case when soft tight fabrics are damaged, as well as brain. Most often, the reason becomes:

1. Primary. At the same time, the vessels, the bones of the skull, the brain fabric, and the shell, are also affected by the likvarny system.
2. Secondary. Do not have a direct connection with brain damage. Their development occurs as a secondary ischemic change in brain fabrics.

There are injuries causing complications, the most common among them:

• edema;
• stroke;
• hematoma.

Be sure to take into account the degree of gravity:

1. Easy. Consciousness is clear, no pain, health does not threaten much.
2. Average. Consciousness is clear, but it is also possible that a person feels a little frightened. Pronounced focal signs.
3. Heavy. Sopor arises, strong stun. Vital actions are broken, there are focal signs.
4. Especially hard. The patient falls into someone, non-dust or deep. Vital functions are violated strongly, as well as the cardiovascular and respiratory system. There is a focal symptom. Consciousness is absent from the pair of hours to many days. The movements of the eyeballs are bliss, and the reaction of pupils on bright stimuli is oppressed.

2 Diagnostic methods and periods of disease

Patients with cranopy and brain injuries must be examined. Based on the determination of the degree of oppression of consciousness, the extent to which neurological symptoms are expressed, whether other organs are damaged, the diagnosis is made. It is more convenient for these purposes to use the scale of Glasgow's coma. Check the condition of the patient immediately after injury, after 12 hours and a day.

The patient is asked to produce certain movements, answer questions and open and close the eyes. At the same time, they monitor the reaction with external irritating factors.

In medicine, several periods of the disease are distinguished:

• acute;
• intermediate;
• remote.

If a shaking occurred, then most often the patient is experiencing a sharp headache. It is possible to loss of consciousness, vomiting arises, the head is spinning.

A man is weak, becomes sluggish. But there is no stagnation in the eye day, the brain is locally not amazed, the cerebrospinal fluid has the same pressure.

If there has happened, then a person has a headache at the point of impact, constant vomiting, difficulty breathing and bradycardia appears, pallor and elevated temperature. During the examination, it is detected:

• in the spinal fluid - the presence of blood;
• in the blood - an increased number of leukocytes.

Maybe violation and speech. At this time, it is necessary to be under the supervision of the doctor, as a traumatic epilepsy may occur, accompanied by attacks of convulsion. And this process often causes depressive states and aggressive behavior, fast fatigue.

Intracranial hematomas, skull fractures can cause brain compression. This is due to various kinds of hemorrhages obtained due to injuries. Often because of hemorrhage that occurred between the bones of the skull and the brain shell, it is at the point of impact, an epidural hematoma occurs. It can be determined by an aisocoria with expansion. Often the loss of consciousness. At the same time, the diagnosis is most often required surgery.

With a subdural hematoma, strong head spasms, vomiting arise, begins to be gathering in subdural space. Blood. A convulsions arise. Patients cannot navigate in space, quickly tired, but at the same time are too excited and irritable.

To confirm the diagnosis caused by injury in the skull area, you will need additional research:

1. X-ray skull when there is a suspicion of his fracture.
2. EMG will help determine what the degree of lesion in muscle fibers and myonevel endings.
3. Neurosonography. With it, it is determined by intracranial hypertension, hydrocephalus.
4. UDG to check whether the pathology did not occur in the brain vessels.
5. Blood chemistry.
6. MRI to define lesions in the brain.
7. EEG to identify dysfunction of stem structures of the brain.

Diagnostics will determine the consequences of the skull injury.

Closed Cherno- brain injury(brain concussion, injury heads-

brain, intracranial hematomas and t. d..)

Protocol code: SP-008.

Purpose of stage: Restoring the functions of all vital systems and organs

CCC codes-10:

S06.0 Brain concussion

S06.1 Traumatic brain swelling

S06.2 Diffuse brain injury

S06.3 Heat brain focal injury

S06.4 Epidural hemorrhage

S06.5 Traumatic subdural hemorrhage

S06.6 Traumatic subarachnoid hemorrhage

S06.7 intracranial injury with a long comatose

S06.8 Other intracranial injuries

S06.9 intracranial injury uncomputed

Definition: Closed Cherno- brain injury(ZCHMT) - damage to the skull and

brain, which is not accompanied by a violation of the integrity of soft tissues of the head and / or

uponework stretching skull.

TO open chmt.damage are accompanied by violation

the integrity of the soft tissues of the head and the aponeurotic helmet of the skull and / or corresponding

wash the fracture zone. The penetrating damage includes such a CMT that has

widges the fractures of the bones of the skull and damage to the solid brain sheath with

the occurrence of liquor fistulas (lycvorea).

Classification:

Pathophysiology CHMT:

- Primary- damage due to direct impact of injuries

powered skull bones, brain shells and brain tissue, brain vessels and liquor

core system.

- Secondary- damage is not associated with direct brain damage,

but due to the consequences of primary brain damage and develop mainly

by type of secondary ischemic changes in cerebral tissue. (intracranial and systems-

1. intracranial- cerebrovascular changes, violations of liquorocyer

liances, brain swelling, changes in intracranial pressure, dislocation syndrome.

2. systemic- arterial hypotension, hypoxia, hyper- and hyperials, hyper- and

hyponatremia, hyperthermia, impaired carbohydrate exchange, DVS syndrome.

In the severity of the state of patients with chmt– based on the evaluation of the degree of coal

the consciousness of the victim, the presence and severity of neurological symptoms,

licacy or absence damage to other organs. The greatest distribution of

chila Glasgow Coma (proposed by G. Teasdale and B. Jennet 1974). Status

giving evaluated at the first contact with the patient, after 12 and 24 hours in three parameters

ram: opening the eye, speech response and motor reaction in response to the external

dragoncy. Allocate the classification of disorders of consciousness at CMT, based on

evaluating the degree of oppression of consciousness, where the following gradations exist

standing consciousness:

Moderate stunning;

Deep stunning;

Moderate coma;

Deep coma;

Foreign coma;

The Light ZChMT includes the concussion of the brain and the brain bruise easy

degree. SCMT of moderate severity - the injury of the brain of medium severity. To

zhelya ZCHMT belongs to the injury of the brain of severe and all types of headings

brain.

Highlight 5 gradations of the status of patients with chmt :

1. satisfactory;

2. Middle severity;

3. Heavy;

4. Extremely severe;

5. Terminal;

Satisfactory condition criteria are :

1. Clear consciousness;

2. No violations of vital functions;

3. Lack of secondary (dislocation) neurological symptoms, absence

ordinary severity of primary semi-coarse and crani-bean symptoms.

There is no threat to life, the displacement of disability is usually good

The criteria of the state of moderate gravity are :

1. Clear consciousness or moderate stunning;

2. Vital functions are not violated (only bradycardia is possible);

3. Focal symptoms - can be expressed by certain half-and-old and crane

basal symptoms. Sometimes single, gently expressed stem

symptoms (spontaneous Nistagm et al.)

To establish the state of moderate severity is enough to have one of

specified parameters. The threat to life is insignificant, the forecast of the restoration of labor

abilities are more likely favorable.

Criteria of severe state (15-60 min. .):

1. Changes in consciousness to deep stunning or spin;

2. Violation of the vital functions (moderate one by one - two indicators);

3. Focal symptoms - stem are moderately expressed (anisocorium, light limitation

rejecting a look up, spontaneous nystagm, contralateral pyramidal failure

the dissociation of meningeal symptoms along the body axis, etc.); can be sharply

wives of half and cranified symptoms, including epileptic seizures,

pares and paralysis.

To establish a difficult state, it is permissible to have these disorders.

would one of the parameters. The threat to life is significant, largely depends on

severe states, disgraceability of ability to restore disability

pleasant.

The criteria for extremely severe state are (6-12 watch ):

1. Violation of consciousness to moderate or deep coma;

2. A sharply pronounced violation of the vital functions in several parameters;

3. Focal symptoms - stem are expressed clearly (parires of the gaze up, expressed

anisocorium, eye divergence vertical or horizontal, tonic spontaneous

nistagm, weakening the reaction of pupils into light, bilateral pathological reflexes,

decerebraction rigidity, etc.); Half and cranified symptoms sharply

expressed (up to bilateral and multiple paresis).

When establishing an extremely severe state, it is necessary to have pronounced

in all respects, and one of them is necessarily the limit, threat for

maximum life. Forecast displacement is more often unfavorable.

Terminal state criteria :

1. Violation of consciousness to the level of the coma;

2. Critical violation of vital functions;

3. Focal symptoms - stem in the form of limit bilateral mydriasis,

the essence of corneal and pupil reactions; Half and craniobasic usually re-

covered with general-selling and stem violations. The forecast of the survival of the patient

emerging.

Clinical forms of CHMT.

By types are highlighted:

1. Isolated;

2. Combined;

3. Combined;

4. Repeated;

Cherno- brain injury shared on:

1. Closed;

2. Open: a) impenetrable; b) penetrating;

By types of brain damage differences:

1. brain concussion - a state that arises more often due to

little traumatic strength. It is found almost 70% of victims of the CHMT.

A concussion is characterized by the lack of loss of consciousness or short-term loss

consciousness after injury: from 1-2 to 10-15 minutes. Patients complain of headaches, Tosh

note, less often vomiting, dizziness, weakness, pain when moving eyeballs.

There may be a light asymmetry of tendon reflexes. Retrograde amnesia (EU-

whether it occurs) short-term. Anterorograd amnesia does not happen. With concussion

the mentioned phenomena of the brain are caused by the functional lesion of the brain and

after 5-8 days pass. To establish a diagnosis, optionally

all specified symptoms. Concussion of the brain is a unified form and not

divided into severity;

2. brain injury - this is damage in the form of macro structural destruction

brain substances, more often with a hemorrhagic component that occurred at the time of the application

traumatic power. On clinical flow and severity of brain damage

brain bums are divided into bruises of light, medium and severe):

Burn brain easy (10-15% of victims). After injury,

rata of consciousness from a few minutes to 40 minutes. Most have retrograde amne

zia for the period up to 30 minutes. If an anterorographic amnesia arises, then she is not

resident After the recovery of consciousness, the victim complains of headache,

nausea, vomiting (often repeated), dizziness, weakening attention, memory. Maybe

to be detected by Nistagm (more often horizontal), anisaneflexia, sometimes light hemiparesis.

Sometimes there are pathological reflexes. Due to subarachnoid hemorrhage

lyans can be detected easily expressed meningeal syndrome. Can observe

brady and tachycardia, transient increase in blood pressure by 10-15 mm Hg.

art. Symptoms regress usually within 1-3 weeks after injury. Injury

a lightweight brain can be accompanied by fractures of the bones of the skull.

Middle Degree Brain Break . The loss of consciousness lasts from

how many dozen minutes to 2-4 hours. Oppression of consciousness to moderate or

deep stun can persist for several hours or days. Observed

a pronounced headache, often re-vomiting. Horizontal nistagm, weakening

the reaction of the reaction of pupils into light is possible to disrupt the convergence. There is a discs

the cyanization of tendon reflexes, sometimes moderately pronounced hemiparesis and pathological

sky reflexes. There may be impairment of sensitivity, speech disorders. Menin

geal syndrome is moderately expressed, and the liquor pressure is moderately increased (

the key to the victims, which have Likvorea). There is tachy or bradycardia.

Respiratory disorders in the form of a moderate tachipne without a rhythm disturbance and does not require appa-

ratish correction. Subfebrile temperature. In the 1st day can be psychomotor

excitation, sometimes convulsive seizures. There is a retro and anteroraterograde amne

Heavy degree brain injury . The loss of consciousness lasts from several hours to

how many days (in part of patients with the transition to appeallic syndrome or akinetic

mutism). Infertility of consciousness to a spin or coma. May be a pronounced psychomotor

an excitation imposing atonia. Stem symptoms are expressed - floating

movement of eyeballs, difference of eyeballs on the vertical axis, fixation

looking down, anisocorium. The reaction of pupils for light and corneal reflexes are depressed. Swallow

nope is violated. Sometimes the city of pain irritation or spontaneously develops.

Bilateral pathological stop reflexes. There are changes in muscle tone

ca, often hemiparez, anisuflexia. There may be convulsive seizures. Violation

breath - on a central or peripheral type (tachy or bradypnee). Arteri

or improved, or reduced (may be normal), and with atonyc

the coma is unstable and requires constant medication support. Expressed

ningleal syndrome.

To the special form of brain bruises diffuse axonial damage

brain . Its clinical signs include a violation of the brain barrel function -

consciousness to a deep coma, a sharply pronounced violation of the vital functions, which

these require mandatory drug and hardware correction. Mortality

diffuse axonal damage to the brain is very high and reaches 80-90%, and

supported appealic syndrome. Diffused axonal damage can

accompanied by the formation of intracranial hematomas.

3. Crazy brain(growing and unlatenizing) - happens by reducing

intracranial space with volume formations. It should be borne

that any "harsh" compression at the CMT can become increasing and lead to

severe compression and dislocation of the brain. To unraoper compresses include

sorrowing bones of skull with indulged fractures, pressure on the brain

mi foreign bodies. In these cases, the comprehensive brain itself is not increased

it is in volume. In the genesis of the brain compression, secondary intracrapers play a leading role

mechanisms. The growing compresses include all types of intracranial hematomas

and brain bruises accompanied by mass effect.

Intracranial hematomas:

1. Epidural;

2. subdural;

3. intracerebral;

4. intraventrices;

5. Multiple subordinate hematomas;

6. Subdural hydromes;

Hematomamay be: sharp(first 3 days) subacle(4 days-3 weeks) and

chronic(Later 3 weeks).

Classical __________ Clinical picture of intracranial hematomas includes availability

light gap, anisocoria, hemiparesis, bradycardia, which meets less often.

The classic clinic is characteristic of a hematoma without a concomitant bruise of the brain. At

suffering from hematomas in combination with brain injury from the first hours

CMT there are signs of primary brain damage and symptoms of compression and dislief

brain kation caused by brain tissue injury.

Risk factors at CMT:

1. Alcoholic intoxication (70%).

2. CMT as a result of an epileptic attack.

Leading reasons for CHMT:

1. Road injury;

2. Household injury;

3. Fall and sports injury;

Diagnostic criteria:

Pay attention to the presence of visible damage to the scalp.

Periorubital hematoma ("Symptom of Points", "Eyes of Raccot") indicates a fracture

the bottom of the front worm. Hematoma in the area of \u200b\u200bthe deputyid process (symptom of butt

la) accompanies the pyramid of the temporal bone. Hhemoxpanum or breaking the drum

noque membrane can correspond to a fracture of the base of the skull. Nose or ear

likvorea testifies to the fracture of the base of the skull and penetrating CHMT. Sound "Tres

dwelled pot "at percussion of the skull may occur during the fractures of the bones of the Code

turnip. Exophthalm with swelling conjunctiva may indicate the formation of carotid

cavernous coolest or on the resulting retrobulbar hematoma. Hematoma soft

kih fabrics in the occipuric cervical region can accompany the fibrous bone

and (or) the bruises of the poles and the basal departments of the frontal fractions and the poles of temporal fraction.

Undoubtedly, the assessment of the level of consciousness, the presence of meningeal

symptoms, the status of pupils and their reaction to the light, the functions of the cranial nerves and

functions, neurological symptoms, an increase in intracranial pressure,

brain dislocation, development of acute likvorn occlusion.

Medical care tactics:

The choice of tactics of treatment of victims determine the nature of the damage

the brain, the bones of the arch and base of the skull, concomitant extra charge injury and

vitia complications due to injury.

The main task in providing first assistance to victimscHMT - not

to start the development of arterial hypotension, hypoventilation, hypoxia, hypercapnia, so

how these complications lead to severe ischemic brain lesions and accompanied

high mortality.

In this regard, in the first minutes and hours after injury, all therapeutic activities

must be subordinated to the Rule "ABC":

BUT(butiRWAY)- Penthood respiratory tract;

IN(Breathing)- Restoration of adequate respiration: elimination of the obstruction of breathing

waters, drainage pleural cavity with pneumatic-, hemotorax, IVL (by

indications);

FROM(circulation)- Monitoring the activities of the cardiovascular system: fast

restoration of the BCC (transfusion of crystalloid solutions and colloids), if not

myocardial accuracy is the introduction of inotropic drugs (dopamine, dobutamine) or vase

pressors (adrenaline, noraderenlin, Meston). It must be remembered that without normal

circulating blood mass The introduction of vasopressors is dangerous.

Indication to the intubation of the trachea and the holding of IVLare apnea and hypoapnoe,

the presence of cyanosis of the skin and mucous membranes. Intubation through the nose has a number of advantages

tC At CMT, the likelihood of a shaven-spinal injury is not excluded (and therefore

all victims affected by the nature of injury on chipboard necessary

dimo fix the cervical spine, overlapping special cervical gates

nicknames). To normalize the arteriovenous oxygen difference in the victims of the CHMT

it is advisable to use oxygen-air mixtures with an oxygen content to

The obligatory component of the treatment of severe CMT is the elimination of hypovole

myi, and for this purpose, liquid is usually introduced in the amount of 30-35ml / kg per day. Except

are patients with acute occlusal syndrome, in which the pace of CSZH products

directly depends on water balance, so they are justified by dehydration, allowing

having reduced pschd.

For the prevention of intracranial hypertensionand her damaging brain

the consequences at the pre-hospital stage are used glucocorticoid hormones and salure

Glucocorticoid hormoneswarn the development of intracranial hypertension

ziya due to stabilization of the permeability of the hematostephalic barrier and reduction

fluid transduction into brain tissue.

They contribute to the decline in peripocal edema in the area of \u200b\u200binjury.

At the pre-hospital stage, it is advisable intravenous or intramuscular introduction

prednisolone in a dose of 30 mg

However, it should be borne in mind that due to the concomitant mineralocorticoid

the prednisone effect is able to delay in the sodium body and strengthen elimination

potassium, which adversely affects the general condition of patients with CMT.

Therefore, it is preferable to use dexamethasone at a dose of 4-8 mg which

practically does not have mineralocorticoid properties.

In the absence of circulatory disorders simultaneously with glucocorticoid

hormones for brain dehydration is possible to assign high-speed salureti-

cOV, for example, Lazix in a dose of 20-40 mg (2-4 ml of 1% solution).

Gangli-blocking drugs high degree intracranial hypertension

contraindicated, since, with a decrease in system blood pressure, it can develop

sia full blockade cerebral blood flow due to the compression of the brain capillaries of the edema

beep tissue.

To reduce intracranial pressure- both in the pre-hospital stage and in

hospital - do not do ituse osmotically active substances (mannitol), for

with a damaged hematorecephalic barrier, create a gradient of their concentration of

waiting for the substance of the brain and the vascular channel fails and probably deterioration

patient due to the rapid secondary increase in intracranial pressure.

Exception - the threat of brain dislocation accompanied by severe

breath disorders and blood circulation.

In this case, it is advisable to intravenous administration of mannitol (mannitol) from the calculation

that 0.5 g / kg body weight in the form of a 20% solution.

The sequence of urgent assistance measures in the feed population-

When concussing a brainemergency care is not required.

With psychomotor excitation:

2-4 ml of 0.5% Sedukesen solution (relaignation, sybazone) intravenously;

Transportation to the hospital (in the neurological department).

When injected and squeezing the brain:

1. Ensure access to Vienna.

2. When developing the terminal state, make a heart resuscitation.

3. When decompensating blood circulation:

Reopolyglyukin, crystalloid solutions intravenously drip;

If necessary - dopamine 200 mg in 400 ml of isotonic sodium solution

chloride or any other crystalloid solution intravenously at speeds

keeping the maintenance of blood pressure at the level of 120-140 mm RT. Art.;

4. With an unconscious state:

Inspection and mechanical cleaning of the oral cavity;

Application of selllick reception;

Implementation of direct laryngoscopy;

Spine in the cervical department do not bind!

Stabilization of the cervical spine (easy pulling hands);

Trachea intubation (without minelaxanths!), regardless of whether

can be found or not; Miorosanta (Succinylcholine Chloride - Dicillin, Leafenon in

dose 1-2 mg / kg; Injections are carried out only by the doctors of resuscitation and surgical

With ineffectiveness of independent respiration, artificial fans are shown

lungs in moderate hyperventilation mode (12-14 l / min for a patient with a body weight

5. In psychomotor excitation, cramps and as premedication:

0.5-1.0 ml of 0.1% of the atropine solution subcutaneously;

Intravenously propofol 1-2 mg / kg, or sodium thiopental 3-5 mg / kg, or 2-4 ml 0.5%

sedukesen solution, or 15-20 ml of 20% sodium solution of oxybutirate, or Dormicum 0.1-

During transportation, the respiratory rhythm is needed.

6. With intracranial hypertensive syndrome:

2-4 ml of 1% furosemide solution (lazix) intravenous (with decomposed

bloodworp due to combined injury laziks do not enter!);

Artificial hyperventilation of the lungs.

7. With pain syndrome: intramuscularly (or intravenously slow) 30mg-1.0

ketorolac and 2 ml of 1-2% diploma solution and (or) 2-4 ml (200-400 mg) 0.5% solution

tram or other nonarcotic analgesic in the respective doses.

Opiates do not enter!

8. When wounds of the head and outdoor bleeding of them:

Wire toilet with edges treatment with antiseptic (see ch. 15).

9. Transportation to the hospital where there is an neurosurgical service; when crying

in the intensive care unit.

List of major medicines:

1. * Dopamine 4% 5 ml; amp

2. Dobutamine solution for infusion 5 mg / ml

4. * Prednisolone 25mg 1ml, AMP

5. * Diazepam 10 mg / 2 ml; amp

7. * Sodium oxybat 20% 5 ml, AMP

8. * Magnesium sulfate 25% 5.0, AMP

9. * Mannitol 15% 200 ml, FL

10. * Furosemid 1% 2.0, AMP

11. Meston 1% - 1.0; amp

List of additional medicines:

1. * Atropine sulfate 0.1% - 1.0, AMP

2. * Betamethasone 1ml, AMP

3. * Epinephrine 0.18% - 1 ml; amp

4. * Destrane 70 400.0; FL

5. * Diphenhydramine 1% - 1.0, AMP

6. * Ketorolak 30mg - 1.0; amp

The closed cranial and brain injury (ZCHMT) is damage to the head, in which the integrity of the connective tissue under the skin of the head (occipital aponeurosis) covering the entire skull is preserved. Skin covers can be oversight. The consequences of a closed cranial injury in the future depends on the intensity of the damaging factor, as well as on which formations of the central nervous system are damaged.

Classification of closed cranial injury

The closed cranial trauma has a cipher on the ICD-10 S00-T98. There are several types of consequences, various gravity and symptoms:

1. with closed brain injury.
2. Traumatic swelling.
3. Injuries: diffuse, focal.
4. Hemorrhage: epidural, subdural, subarachnoidal.
5. Coma.

Symptoms

Signs of closed cranial injury include a violation of consciousness, a change in reflexes, memory loss (amnesia). The victim can be in consciousness, and without him. The main symptoms of a closed cranial injury:

1. Stunning, stupor, loss of consciousness.
2. Incoherent speech.
3. Nausea, vomiting.
4. Excited or inhibited state.
5. Violation of a sense of equilibrium.
6. Cramps.
7. Loss of reaction of pupils into light.
8. Disturbance of swallowing, breathing.
9. Circles around the eyes (symptom of glasses).
10. Reduced arterial pressure (sign of damage to the bulbar department).

The unconscious or stunned state is a characteristic SCMT symptom caused by the death of nerve cells. The victim can be excited, aggressive or inhibited and not react to stimuli.

It gives severe pain, nausea, vomiting, in which the contents of the stomach can be hit in the respiratory tract. As a result, asphyxia (choking) is possible or aspiration pneumonia. With an increase in intracranial pressure, convulsive syndrome often develops.

With a patient, a shaky gait is observed, trembling eyeballs. Damage to the vessels with severe injury causes the formation of a large hematoma that gives rise to the formation of the central nervous system.

The swallowing disrupting develops under the damage to the stem department, in which the cores of the cranial nerves are located. Memory loss - frequent symptom of brain damage. However, it can and restore in some cases.

Vegetative manifestations are possible, such as excessive sweating, violation of cardiac activity, redness or pacelas. Reduced blood pressure - a sign of damage to the pressing department of the oblong brain. The displacement of the tissue of the brain (dislocation syndrome) is manifested in various pupils.

Emergency care with closed brain injury

It is necessary to deliver a person to a medical facility as soon as possible, not allowing a strong shaking during transportation. In vomiting, in combination with an unconscious state, it is necessary to put the patient so that the head is turned on the side and the lots of mass fluidly flow through the mouth, without falling into the respiratory tract.

Diagnostics

The victim is necessary to inspect a neuropathologist and traumatologist. Feldsher ambulance should interview witnesses about the incident. With shocks and brain bruises, they check the reaction of pupils into light, as well as its symmetry. Test tendons and other reflexes.

To diagnose damage, ultrasound examination, magnetic resonance imaging, and sometimes radiography and CT. When comatic condition, the severity in the scores on the Glasgow scale is evaluated. A general blood test is also carried out, a coagulogram, a biochemical blood test from the finger on glucose.

Treatment of closed cranial injury

Treatment of patients with closed traumatic lesions of the head depends on the severity of damage, the health status of the patient. After diagnosing damage, the following comprehensive measures are used:

1. At the edema of the brain and elevated intracranial pressure prescribed dehydration therapy. Digestive means (furosemid, mannitis) eliminate the edema of the brain, which provokes convulsive seizures.
2. At headaches are prescribed analgesics.
3. To reduce intracranial pressure and improve the venous outflow, the patient's head is raised above the body level.
4. Salted products are excluded from the diet.
5. In the case of preserving the convulsive syndrome, it is stopped by anti-wurals.
6. If the dumping masses occurred in the respiratory tract, they are aspiration using a pump.
7. Breathing disorder requires intubation. At the same time, all important life indicators are monitored: oxygen saturation level, heart rate.
8. If the swallowing function is broken, the patient is powered by a nasogastric probe.
9. If there is a hematoma, threatening the brothering of the brain barrel, is removed by operation with the trepanitation of the skull.
10. Antibacterial agents are used to treat infection (, encephalitis).
11. Eliminate the consequences of a closed cranial injury. Again antihypoxic agents: Mexidol, cytooflavin, cerebrolysin.
12. Recommend acupuncture. The procedure will help with residual paralysis.
13. RANC is prescribed - the method of restoring the activity of brain centers, which improves the condition of patients in a coma.

To mitigate residual phenomena, rehabilitation is necessary: \u200b\u200blearning oral speech, writing, practical skills. Memory recovery occurs with the help of relatives and loved ones. To eliminate the disorder of microcirculation and memory recovery, nootropic drugs are used: piracetam, nootropyl, cavinton, starburon improve the blood circulation of the brain, weaken the intracranial hypertension syndrome.

Conclusion

Closed head damage has various severity. Easy degree can pass unnoticed for the victim, but it does not cancel the treatment of a traumatologist. The affected necessarily needs to make a radiological examination of the head. With severe lesions, a comatose state is developing, threatening life, especially in the presence of dislocation syndrome.

Card and brain injury is a mechanical disorder of the integrity of the bones of the skull, blood system and brain substances. The result of obtaining CMT is the development of the traumatic disease of the brain (TBGM), the success of the therapy of which depends on the set of indicators, degree of destruction and the speed of providing qualified medical care.

By international Classification The diseases of the ICB-10 CMT are located in the S00-T98 section "Injuries, poisoning and some other consequences of exposure to external reasons", and for the consequences, a separate structure of T90-T98 "The consequences of injuries, poisoning and other effects of external reasons" was allocated.

In the process of identifying crank-brain injuries, experts define the mechanics for obtaining impact, the type of injury; Type, character, shape and severity of injury. During medical procedures for curing consequences, therapy and its end result is also estimated.

According to the mechanics of receiving TFMT, they share:

1. Shock-shockproof (violation of the integrity of the brainstant is located at the point of application of impact and on the reverse side);
2. Accelerated-slow (shock wave moves the final department to the brain barrel, causing the internal structures);
3. Combined or combined (combines both types of previous damage).
   At the location of localization, the cranial and brain injuries are classified:

• focal (violation of the integrity of the brainstanty is clearly localized within the borders of obtaining a strike, except in cases where the vessels are additionally present in the impact zone, the opposite side and along the shock wave);
• diffuse (as a result of the injury, complications arise in the form of a subsequent obstruction of axons in deep brain departments, cornstone, functional centers, brain trunk);
  Combined (combines both types of injury).

By the time of the consequences of the CMT, the following types are distinguished:

• primary (focal cerebral injuries, diffuse-axonal injury, primary intracranial hemorrhages, broken brain structures, multiple intracerebral bleeding);
• secondary (arise due to insufficient blood circulation and the spinal fluid, brain edema, overflow of the blood circuit system);
• due to secondary extra charge factors (hypertension, excess CO2 content, lack of oxygen, anemia).

In addition, the CMT is:

1. Closed (characterized by the lack of damage to the skin, bones of the skull, sometimes there is a bone offset, but without the destruction of the surrounding tissues).
2. The open, which is also divided into: not penetrating, without disturbing the integrity of the bones of the skull and brain shells. For example, the injury of the head, the reason for which is the scalp wound of the frontal area of \u200b\u200bthe head; penetrating, with mandatory injury of the scalp, solid shell, etc.
3. Isolated (not having outside cranial damage).
4. Combined (outside the cranal injury, extended as a result of mechanical exposure).
5. Combined (develop as a result of the effects of several types of energies: mechanical, thermal, radiation, chemical).

Experts divide the CHHMT into several degrees of gravity: light, middle and heavy in accordance with the gloomy glory scaly of the coma. So, an easy degree is located in the range of 13-15 points, the average - 9-12, and heavy - from 8 or less points. Frequent satellite heavy CMT is post traumatic encephalopathy, due to which during the year, the patient shows mental, mental, vestibular deviations. Also, he can have epileptic seizures, paralysis. According to the ICD-10, this disease is usually under the code T90.5 "The consequences of intracranial injury" or G93.8 - "Other clarified brain diseases".

Clinically highlighting:

• concussion;
• brain injury;
• easy degree;
• moderate;
• severe;
• diffuse trauma of axons;
• compression of brain structures.

Also, after injury, experts evaluate the acute, intermediate and remote period of the disease. The acute period lasts from 2-10 weeks, intermediate - 2-6 months, distant when healing is up to 2 years.

In the first moments, after obtaining injury, the traumatic brain disease is expressed in pain, vomiting, stupid consciousness, increasing intracranial pressure, drowsiness, the decline of forces and inability to see clearly. Sometimes, even in the absence of visible and explicit signs, due to the receipt of CMT, the skull vertebrae is shifted, which leads to painful syndrome in the neck, deterioration of attention, excessive fatigue.

Frequent satellites of CMT of various complexity are the neurosis of the facial and glasses, which are accompanied by paralysis of the face muscles.

Consequences of head injuries

After receiving the FMT, in most cases, the injurious disease of the brain (TBGM) is diagnosed, which is accompanied by functional disabilities in the body work, and mental disorders during brain injuries are also possible. An impetus to the development of this violation can be any head injury, as a result of which the displacement or destruction of the structures of the brain occurred.

Shocked brain structures. It is found in most clinical cases due to hit head about a solid surface. It is characterized by a short-term loss of consciousness - on average up to 15 minutes. As the consequences of concussion, headache, nausea, vomiting, powerlessness and soreness when trying to rotate through their eyes. These manifestations are held a week after the injury, although in the future they can slightly influence ability to work.

Grinding brain. Arises against the background of the hematoma inside the cranial box, which leads to a decrease in the volume of the skull's cavity. It often affects the brain barrel, so the control of the performance of vital functions of the brain is suffering, such as respiration and blood circulation.

Brain substance injury. The degree of brain lesion is established clinically and depends on the number of pathologies that were caused by CMT. For example, the brain injury is easy to express in minor neurological deviations for a month, and in a severe - long-term memory loss and long-finding patient in an unconscious state.

Traumatic brain swelling occurs due to the accumulation of fluid in the functional tissues of the organ, mainly glial. Destruction of axonial ties. Since the neurons are transmitted to other parts of the body with the help of axons, their injury and gap leads to the cessation of cortical activities, while the patient flows into a comatose state.

Intracranial hemorrhage. As a result of hitting the head in the cavity of the skull often, the walls are rupture blood vessels With all the ensuing consequences:

• Prolapse of brain substance.
• Powering of liquor, both outdoor and internal.
• Fit and accumulation of air inside the cranial box.
• Increase intracranial pressure.
• Formation of cyst, tumors, scars and adhesions, the development of hydrocephalus.
• Due to the pollution of the wound, inflammation can begin, forming fistulas, infection and brain tissue abscess.

In the long run, the THMT can provoke the development of vegetative disorders, which will subsequently complicate the life of the victim for several years. These include worsening hearing, speech clarity, loss of vision right up to full blindness, violation of eye mobility, sleep disorder and memorization processes, confusion.

Mental disorders for crank and brain injuries are also frequent, for example, due to the destruction of brain structures, post-traumatic epilepsy, Parkinson's disease, organ dysfunction may occur.

First aid for head injuries

The testing of first medical care at CMT depends on how external damage to the head of the head and conditions under which traumatic brain disease developed.

For a start, assisting should evaluate the clarity of the consciousness of the victim, the response reaction of pupils on the external stimuli, the severity of the headache (if it is talking), the presence of respiratory and swallowing movements. Also before the arrival of the ambulance brigade draw attention to the skin color, measure pulse, heart rate, body temperature and blood pressure. Further, on the basis of these knowledge, the Medic will set the degree of damage to the brain and prescribe the right therapy.

If the victim is unconscious, then his head must be rotated the side and pull out the language. This is done to prevent the vigorous language and penetration of the vomit in the respiratory tract. With an open wound, a gulling bandage is superimposed. If the victim does not breathe, it turns out to be standard in these cases - make artificial ventilation of the lungs by any of the ways: from the mouth to the mouth "," mouth to the nose "and the indirect heart massage.

When first aid, especially when the victim is unconscious, it is necessary to handle it extremely gently and not move to the emergence of ambulances.

Restorative therapy

The duration of the rehabilitation period after receiving the injury of the head and neck is determined based on the assessment of the severity of damage caused by the health. For example, a slight brain concussion does not require special medical procedures, and the patient quickly leaves the hospital.

At the same time, severe CMT is subject to mandatory therapy in a hospital, since there is often surgical assistance in such cases, to establish the likvorn paths, removal of foreign objects from the wound and restoring blood supply on the injured brain substance.

People who have received severe injury can not independently recover from the consequences. Often they completely lose their life skills and in the future they learn to speak independently, moving and communicate with others.

To do this, all known physiotherapeutic treatments are used: physical education, massage, manual therapy and classes with speech therapist. If necessary, the patient needs psychotherapeutic assistance - to return the memory and ability to analyze the incoming information.

In addition to the procedures listed above, during rehabilitation, people with head injuries are prescribed treatment involving the use of medication tools in stimulating work, blood supply and restoration of brain performance.

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Short description

The closed cranial and brain injury (SHMT) is damage to the skull and brain, which is not accompanied by a disruption of the integrity of soft tissues of the head and / or aponeurotic stretch of the skull.
The open CMT includes damage, which are accompanied by a violation of the integrity of soft tissues of the head and the aponeurotic skull helmet and / or
correspond to the zone of the fracture.

Penetrating damage includes such a CMT, which is accompanied by fractures of the skull bones and damage to the brain sheath with the occurrence of liquor fistulas (liquor, and the occurrence of liquor fistulas.
Protocol code: E-008 "Closed brain injury (concussing brain, brain injury, intracranial hematomas, etc.)"
Profile: Ambulance Stage Help: Restoration of the functions of all vital systems and organcodes (codes) on the ICD-10-10:
S06.0 Brain concussion
S06.1 Traumatic brain swelling
S06.2 Diffuse brain injury
S06.3 Heat brain focal injury
S06.4 Epidural hemorrhage
S06.5 Traumatic subdural hemorrhage
S06.6 Traumatic subarachnoid hemorrhage
S06.7 intracranial injury with a long comatose
S06.8 Other intracranial injuries
S06.9 intracranial injury uncomputed

Classification

According to Pathophysiology, TWF:
1. Primary - damage is due to the direct effects of traumatic forces on the bones of the skull, brain shells and brain tissue, brain vessels and a liquor system.
2. Secondary - damage is not associated with direct brain damage, but are due to the consequences of primary brain damage and develop mainly by the type of secondary ischemic changes in cerebral tissue (intracranial and systemic).
Intracranial - cerebrovascular changes, disorders of liquorocirculation, brain swelling, changes in intracranial pressure, dislocation syndrome.
Systemic - arterial hypotension, hypoxia, hyper- and hypocria, hyper-and hyponatremia, hyperthermia, impaired carbohydrate metabolism, DVS syndrome.
According to the severity of the patients with CMT, it is based on an assessment of the degree of oppression of the consciousness of the victim, the presence and severity of neurological symptoms, the presence or absence of damage to other organs. The largest distribution was the scale of Glasgow's coma (proposed by G. Teasdale and B. Jennet 1974). The condition of the victims is estimated at first contact with the patient, after 12 and 24 hours in three parameters: opening the eye, speech response and motor reaction in response to external irritation.

Allocate the classification of disorders of consciousness at CMT, based on a qualitative assessment of the degree of oppression of consciousness, where the following gradations of the state of consciousness are existed:
- Clear;
- moderate stunning;
- Deep stunning;
- Sopor;
- moderate coma;
- Deep coma;
- Foreign coma;

The Light SCMT includes the concussion of the brain and the bruise of the brain of easy degree.
SCMT of moderate severity - the injury of the brain of medium severity.
The heavy SCMT includes a severe brain injury and all types of brain compression.
5 gradations of the status of patients with CMT are distinguished:
- satisfactory;
- moderate;
- severe;
- extremely severe;
- Terminal.
The criteria of a satisfactory state are:
- clear consciousness;
- no violations of vital functions;
- the absence of secondary (dislocation) neurological symptoms, the absence or the unwitting severity of primary semi-coarse and crani-bean symptoms. There is no threat to life, the displacement of disability is usually good.
The criteria for the state of moderate gravity are:
- Clear consciousness or moderate stunning;
- Vital functions are not violated (only bradycardia is possible);
- Focal symptoms - those or other half-and-coordinated symptoms can be expressed. Sometimes single, gently pronounced stem symptoms (spontaneous nystagm, etc.) are observed.
To establish the state of the average severity, it is enough to have one of the specified parameters. The threat to life is insignificant, the displacement of disgraceability is more often favorable.
Criteria of severe condition (15-60 minutes):
- change of consciousness to deep stuning or sopor;
- violation of the vital functions (moderate one-two indicators);
- focal symptoms - stem are moderately expressed (anisocorium, easy limitation of the gaze, spontaneous nystagm, contralateral pyramidal failure, dissociation of meningeal symptoms along the axis of the body, etc.); Keeping and cranched symptoms, including epileptic seizures, paresis and paralysis, can be sharply expressed.
To establish a difficult state, it is permissible to have specified disorders at least one of the parameters. The threat to life is significant, largely depends on the duration of severe state, the displacement of disability is more often unfavorable.
The criteria for extremely severe state are (6-12 hours):
- violation of consciousness to moderate or deep coma;
- a pronounced violation of the vital functions in several parameters;
- focal symptoms - stem are clearly pronounced (pair of gaze, expressed anisocorium, eye divergence vertical or horizontal, tonic spontaneous Nistagm, weakening the reaction of pupils into light, bilateral pathological reflexes, decertainment rigidity, etc.); Half and crani-bean symptoms are sharply expressed (up to double-sided and multiple paresis).
When establishing an extremely difficult state, it is necessary to have pronounced violations in all respects, with one of them necessarily the limit, the threat to life is maximum. Forecast displacement is more often unfavorable.
Terminal state criteria:
- violation of consciousness to the level of the coma;
- Critical violation of the vital functions;
- focal symptoms - stem in the form of limit bilateral mydriasis, lack of corneal and pupil reactions; Half and craniobasic are usually blocked by general-selling and stem violations. The prognosis of the survival of the patient is unfavorable.
Clinical forms of CHMT
By types allocate:
1. Isolated.
2. Combined.
3. Combined.
4. Repeated.
Card injuries are divided into:
1. Closed.
2. Open:
- impenetrable;
- penetrating.
By type of brain damage differences:
1. The concussion of the brain is a state that arises more often due to the effects of a small traumatic force. It is found almost 70% of victims of the CHMT. A concussion is characterized by the lack of loss of consciousness or a short-term loss of consciousness after injury: from 1-2 to 10-15 minutes. Patients complain of headaches, nausea, less often - vomiting, dizziness, weakness, soreness when moving eyeballs.
There may be a light asymmetry of tendon reflexes. Retrograde amnesia (if it occurs) short-term. Anterorograd amnesia does not happen. By shaking the brain, the specified phenomena are caused by the functional damage of the brain and after 5-8 days pass. To establish a diagnosis, it is not necessary for all specified symptoms. A concussion of the brain is a unified form and is not divided into severity.
2. The brain injury is damage in the form of macro structural destruction of the brain substance, more often with the hemorrhagic component that occurred at the time of the application of the traumatic force. According to the clinical course and severity of injuries of cerebral tissue, the bruises of the brain are divided into bruises of light, medium and severe.
3. The brain injury is a light degree (10-15% of victims). After the injury, the loss of consciousness is noted from a few minutes to 40 minutes. Most has retrograde amnesia for the period up to 30 minutes. If an anterorograde amnesia arises, then it is short. After the recovery of consciousness, the victim complains of headache, nausea, vomiting (often repeated), dizziness, weakening attention, memory.
Can be detected - nystagm (more often horizontal), anisaneflexia, sometimes light hemiparesis. Sometimes there are pathological reflexes. Due to subarachnoid hemorrhage, an easily pronounced meningeal syndrome can be detected. Brady and tachycardia can be observed, a transient increase in blood pressure by 10-15 mm Hg. Art. Symptoms regress usually within 1-3 weeks after injury. The brain injury is easy to gravity may be accompanied by fractures of the bones of the skull.
4. Middle severity brain injury. The loss of consciousness lasts from several tens of minutes to 2-4 hours. The oppression of consciousness to a moderate or deep stun can be stored for several hours or days. There is a pronounced headache, often re-vomiting. Horizontal Nistagm, the weakening of the reaction of pupils into light, possibly disruption of convergence.
Dissociation of tendon reflexes, sometimes moderately pronounced hemiparesis and pathological reflexes are noted. There may be impairment of sensitivity, speech disorders. Meningkeal syndrome is moderately expressed, and the liquor pressure is moderately increased (with the exception of victims, which have Likvorea).
There is tachy or bradycardia. Breathing disorders in the form of a moderate tachipne without disturbing rhythm and does not require hardware correction. Subfebrile temperature. In the 1st day can be psychomotor excitation, sometimes convulsive seizures. There is retro and anterorograd amnesia.
5. Heavy degree brain injury. The loss of consciousness lasts from several hours to several days (in part of patients with the transition to appeallic syndrome or akinetic mutism). Infertility of consciousness to a spin or coma. There may be a pronounced psychomotor excitation that replaced atonia.

Stem symptoms are expressed - floating movements of the eyeballs, the difference of eyeballs along the vertical axis, fixing the look down, anisocorium. The reaction of pupils for light and corneal reflexes are depressed. Swallowing is broken. Sometimes the city of pain irritation or spontaneously develops. Bilateral pathological stop reflexes. There are changes in muscle tone, often hemiparez, anisaneflexia. There may be convulsive seizures.

Breathing disorder - on a central or peripheral type (tachy or bradypnee). Blood pressure or elevated, or reduced (may be normal), and in an atonic coma is unstable and requires constant medical support. Meningkeal syndrome is expressed.
The diffuse axonal brain damage includes the special form of the brain bruises. Its clinical signs include a violation of the function of the brain barrel - the oppression of consciousness to the deep coma, a pronounced violation of the vital functions, which require mandatory drug and hardware correction.

Mortality in diffuse axonal brain damage is very high and reaches 80-90%, and the survivors develop appealic syndrome. Diffuse of axonal damage may be accompanied by the formation of intracranial hematomas.
6. The compression of the brain (increasing and unlatenizing) - occurs due to the reduction of intracranial space by volume formations. It should be borne in mind that any "unlatenizing" compression of the CMT can become increasing and lead to severe compression and dislocation of the brain. The unlatenizing compresses include grinding bones of skull with indulged fractures, pressure on the brain by other foreign bodies. In these cases, the comprehensive brain itself is not increasing in volume.

In the genesis of the brain compression, secondary intracranial mechanisms play a leading role. The growing compresses include all types of intracranial hematomas and brain bruises, accompanied by mass effect.
Intracranial hematomas:
- epidural;
- subdural;
- intracerebral;
- intraventrices;
- multiple subordinate hematomas;
- subdural hydromes.
Hematoma can be: sharp (first 3 days), subacute (4 days-3 weeks) and chronic (later 3 weeks).
The classic clinical picture of intracranial hematomas includes the presence of a light gap, anisocorium, hemiparesis, bradycardia, which is less common. The classic clinic is characteristic of a hematoma without a concomitant bruise of the brain. In victims with hematomas, in combination with the brain injury, from the first hours of CHMT, there are signs of primary damage to the brain and the symptoms of the compression and dislocation of the brain due to the injury to the brain tissue.

Risk factors and groups

1. Alcoholic intoxication (70%).
2. CMT as a result of an epileptic attack.
Leading reasons for CMT:
1. Road injury.
2. Household injury.
3. Fall and sports injury.

Diagnostics

Diagnostic criteria

Pay attention to the presence of visible damage to the scalp.
Periorbital hematoma ("Symptom of Points", "Eyes of the Raccoon") indicates a fracture of the bottom of the front cranial fossa.
The hematoma in the departure process (symptom of Battla) accompanies the pyramid of the temporal bone.
Hhemecipanum or rupture of the eardrum may correspond to the fibement of the base of the skull.
The nose or earrings is indicated by the fracture of the base of the skull and penetrating CMT.
The sound of the "cracked pot" during the percussion of the skull may occur during fractures of the bones of the skull of the skull.
Exophthalm with swelling conjunctiva may indicate the formation of carotoid-cavernous calf or on the resulting retrobulbar hematoma.
The hematoma of soft tissues in the occiput and cervical region can accompany the fibust of the occipital bone and (or) the bust of the poles and the basal departments of the frontal fractions and the poles of temporal fractions.
Undoubtedly, the assessment of the level of consciousness, the presence of meningeal symptoms, the state of pupils and their reaction to the light, the functions of the cranial nerves and motor functions, neurological symptoms, an increase in intracranial pressure, brain dislocation, the development of acute likvorn occlusion.

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Treatment

Medical care tactics
The selection of the treatment tactics of victims determine the nature of the brain damage, the bones of the arch and the base of the skull, concompriting the extra charge injury and the development of complications due to injury.
The main task in providing first assistance to victims of the CHMT is to prevent the development of arterial hypotension, hypoplation, hypoxia, hyperkapinia, since these complications lead to severe ischemic brain lesions and are accompanied by high mortality.
In this regard, in the first minutes and hours after injury, all therapeutic activities should be subordinated to the AVC Rule: A (AIRWAY) - the provision of respiratory pathways. In (Breathing) - Restoration of adequate respiration: elimination of the obstruction of the respiratory tract, drainage of the pleural cavity Pneumatic, gemotorax, IVL (according to indications). With (circulation) - control over the activities of the cardiovascular system: fast recovery BCC (transfusion of crystalloid and colloid solutions), with deficiency of myocardium - the introduction of inotropic drugs (dopamine, dobutamine) or vazopressors (adrenaline, noradrenaline, Meston). It is necessary to remember that without the normalization of the mass of circulating blood, the introduction of vasopressors is dangerous.
The testimony for the intubation of the trachea and the holding of the IVL are apnea and hypoapnoe, the presence of a cyanosis of the skin and mucous membranes. Intubation through the nose has a number of advantages, because At the CHMT, the likelihood of a cervical and spinal injury is not excluded (and therefore, all injured injury to clarify the character of the spine, imposing special cervical collars in the pre-hospital stage, imposing special neck collars). To normalize the arteriovenous oxygen difference, the use of oxygen-air mixture with an oxygen content of up to 35-50% is advisable.
The obligatory component of the treatment of severe CMT is the elimination of hypovolemia, and for this purpose, a liquid is usually administered in a volume of 30-35 ml / kg per day. The exceptions are patients with acute occlusal syndrome, in which the pace of CCC products directly depends on the water balance, so they are justified by dehydration, which allows to reduce the PCD.
For the prevention of intracranial hypertension and its damaging brain of consequences, glucocorticoid hormones and saluretics are used in the pre-hospital stage.
Glucocorticoid hormones warn the development of intracranial hypertension due to the stabilization of the permeability of the hematorecephalic barrier and reduce the transvisation of the liquid into the brain tissue.
They contribute to the decline in peripocal edema in the area of \u200b\u200binjury.
In the pre-hospital stage, it is advisable to intravenous or intramuscular administration of prednisolone at a dose of 30 mg.
However, it should be borne in mind that due to the concomitant mineralocorticoid effect, prednisolone is able to delay in sodium organism and enhance the elimination of potassium, which adversely affects general condition{!LANG-c12027e60a9f17f3bf152886b443eff5!}
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1. Primary. At the same time, the vessels, the bones of the skull, the brain fabric, and the shell, are also affected by the likvarny system.
2. Secondary. Do not have a direct connection with brain damage. Their development occurs as a secondary ischemic change in brain fabrics.

There are injuries causing complications, the most common among them:

• edema;
• stroke;
• hematoma.

Be sure to take into account the degree of gravity:

1. Easy. Consciousness is clear, no pain, health does not threaten much.
2. Average. Consciousness is clear, but it is also possible that a person feels a little frightened. Pronounced focal signs.
3. Heavy. Sopor arises, strong stun. Vital actions are broken, there are focal signs.
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