First emergency aid for head injury

The urgency of treatment and diagnosis of craniocerebral trauma nowadays does not cause doubts: deterioration of living conditions, unemployment, growing crime, drug addiction increase criminal traumatism. Because of the increased consumption of alcohol and drugs, frequent overdose( narcotic coma), it became more difficult to differentiate craniocereberal trauma in a coma;In addition, the lack of modern diagnostic equipment in hospitals also does not contribute to this, therefore, a thorough history and examination of the patient becomes more important. In the basis of damage to the brain tissue, head injuries are primarily due to mechanical factors: compression, tension and displacement. The displacement of the brain substance can be accompanied by rupture of the vessels, a brain contusion about the skull bone. These mechanical disorders are supplemented by complex biochemical disorders in the brain.

Craniocerebral injuries are divided into closed and open( penetrating and non-penetrating).

Closed injuries are divided into concussion, bruise and compression. Conditionally, closed fractures are also attributed to a fracture of the base of the skull and a crack in the arch, while maintaining the skin over them.

Concussion is characterized by a triad of signs: loss of consciousness, nausea or vomiting, retrograde amnesia;there is no focal neurological symptomatology.

Brain contusion is diagnosed in cases in which cerebral symptoms are supplemented by signs of focal brain lesions. Allocate a bruise of mild, moderate, severe severity.

A mild degree of injury is characterized by turning off the mind after an injury from a few minutes to 1 hour. After the restoration of consciousness, complaints are made for headache, dizziness, nausea, repeated vomiting. Mark retro and antegrade amnesia, i.e.the patient does not remember anything before and after the injury. Neurological symptoms are not clearly expressed, it consists in asymmetry of limb reflexes, nystagmus, which gradually disappear in the 2-3 weeks after the injury.

The brain contusion of the middle degree is characterized by the switching off of consciousness for a period of several minutes to 4-6 hours. The marked phenomena of amnesia( retro and antegrade) are noted. Complaints about a headache, repeated vomiting. Possible transient disorders of vital organs: brady or tachycardia, increased respiration, fever to subfebrile digits. In the neurological status, a distinct focal symptomatology is noted, depending on the location of the concussion focus;paresis of extremities, sensitivity disorders, speech disorders, pupillary and oculomotor disorders, meningeal symptoms and others, which begin to smooth out gradually 3-5 weeks after trauma for a long time.

A severe brain contusion is characterized by a switch-off for a period of several hours to several weeks, during which marked motor excitement is noted. There are severe violations of vital functions: increased blood pressure, brady or tachycardia, violation of the frequency and rhythm of breathing, including pathological breathing. Hyperthermia is expressed. In the neurological status, the symptoms of the primary lesion of the brain stem( floating movements of the eyeballs, paresis of the eye, disruption of swallowing, Babinsky's reflex) are more prevalent. Sometimes there are convulsive seizures. All these symptoms regress slowly, for months and years, against the background of pronounced mental disorders.

Brain compression can be caused by intracranial hematoma, depressed by fracture of the skull bones, leading to a brain injury. To squeeze the brain more often characterized by the presence of a "light gap", which with severe brain damage may not be. The compression of the brain develops against a background of bruises of varying severity. It is characterized by a life-threatening increase in cerebral symptoms( increased headache, repeated vomiting, psychomotor agitation, etc.);focal symptoms( the appearance and growth of paresis of limbs or hemiparesis up to paralysis, a violation of sensitivity, etc.), the emergence of stem symptoms( the emergence or deepening of bradycardia, respiratory distress or swallowing).One of the pathological symptoms, usually indicating the presence of intracranial hematoma, is a sharp dilatation of the pupil on the side of the hematoma( anisocoria), as well as the appearance of epileptic seizures. It should be remembered that the severity of the craniocerebral trauma does not always coincide with the severity of the patient's condition, since the latter can be caused by severe cumulative damage leading to, in addition to impairment of consciousness and focal neurological disorders, which are criteria for the severity of brain injury, to violations of vital body functions.

First aid .All victims with a closed craniocerebral trauma are hospitalized on a stretcher in the neurosurgical department. In case of concussion and brain contusion of mild degree, a solution of analgin should be administered 50% -in 2 ml + a solution of dimedrol 1%-1 ml.

With moderate and severe brain contusions, if the patient is unconscious, you should put it on your back, clean your mouth and throat of mucus, blood, other foreign bodies;they carry the ventilator with an Ambu bag, or with an apparatus of the KI-3M type;or "mouth to mouth".Intravenously inject 40-60 ml of 40% glucose and 40 ml of lasix( if there is no low blood pressure).Enter intravenously solutions of either GHB( 10-20 ml), or Relanium( 10-20 ml), to prevent seizures. To 40% glucose, 10-20 ml of pyracetam( nootropol) are added.

If blood pressure is low, begin the infusion of polyglucin( 400 ml with 60-90 mg of prednisolone), Lasix with low blood pressure can not be administered. You can not also inject morphine, omnopon, camphor, as they raise intracranial pressure. In the horn, the airway is introduced and, without stopping the infusion, transport the patient.