Treatment of combined traumatic brain injury
Traumatology / / August 12, 2017
combined treatment of traumatic brain injury should be differentiated depending on the severity of brain damage in three groups:
1. Trauma, including brain damage in the form of shock and mild injuries. This combination is more favorable to treat injury associated other body parts, including fractures.Treatment of the most traumatic brain injury in this case should be directed to the normalization of the highest functions and autonomic nervous activity, to ensure normal breathing, fluid and electrolyte balance.In the absence of blood loss associated with other trauma centers, especially important to monitor the condition and dynamics of the intracranial pressure.
Increased cerebrospinal fluid pressure to 1.96 kPa (20 cm water. V.) Or more is an indication for lumbar punctures and unloading osmotherapy (intravenous infusion of 40% glucose solution up to 60 ml, intramuscular injection of 20 ml of 25% magnesium sulfate solution).Quick intracranial pressure-lowering effect (in minutes) is achieved by ad
2. Trauma, including severe cranial damage (fracture of the roof and base of the skull, brain moderately severe brain injuries).In this group of patients often have to decide whether to intervene on the compression and IMPRESSION fractures of the cranial vault, the use of decompressive craniotomy hematoma due to compression of the brain and the possibility of an early emergency surgery for concomitant injuries.The majority of surgical interventions on the other foci of multiple trauma patients in this group performed 2-3 weeks.
3. Trauma, including extremely severe craniocerebral damage (severe injuries and irreversible destruction of the brain).It is obvious that the presence of collateral damage to other parts of the body such cranial trauma usually becomes lethal.The highest value at the same time have the most severe combination of skull injuries: "skull + chest", "skull + abdomen", "skull + limb."In assisting such patients accurate topical diagnostics temporarily recedes into second place, the main efforts are directed to the recovery of the most important functions of the body.
injury of the limbs and head injury were observed in 96.4% of the victims.The greatest practical importance is the combination of traumatic brain injury with a fractured femur.Every second victim to this type of injury is delivered in a state of traumatic shock, most of them are in need of surgical treatment.
special gravity of the injury is different, which make "participation» head injury and fractures shin. In patients with these injuries injury primarily associated with traffic accidents.Therefore, every third patient has fractures of other parts of the skeleton: the pelvis, ribs, upper limbs, the shoulder girdle.Immobilization plaster bandages fragments of leg bones can create a patient with a head injury in a moving bed mode that prevents the development of his stagnation in the lungs and bedsores on the back surface of the body and limbs.You should always remember easily arise general compression of the entire limb and local pressure to form gypsum necrosis of the skin and pressure sores in patients with cranial trauma without any reaction of this pathology, especially in the first 5-7 days of the acute period.
Prevention of bedsores from plaster casts for injuries of the skull is or imposition of the original plaster Longuet trough the period of the unconscious, somnolence or serious condition then converting them into circular plaster casts - the swelling has subsided field limbs or cutting primary superimposed circular cast.
skeletal traction in the presence of severe cranial trauma less "user-friendly", since it is significantly affected immobilized, often placed on a raised foot end of the bed, which contributes to brain congestion, enhance post-traumatic intracranial bleeding and leads to stagnation in the lungs.
As a pre-treatment can be applied combined method of fixation by an external fixation device (element Ilizarov frame) and longetnyh plaster bandages.This method allows you to satisfactorily reponirovat fragments and hold them for the entire period of the unstable condition of the victims.At the same time patients can flip, shift, transport, fix in the required position during motor excitation (eg, delirium), and so on. N.
Minor trauma and speed of implementation of such immobilization allows to use it even for extremely heavy patients.After 3-5 weeks after normalization of the general condition stable, the patient made a full Transosseous osteosynthesis by Ilizarov circular or apply a plaster cast.
characteristic feature combinations traumatic brain injury and multiple rib fractures is to develop in victims of acute respiratory failure dual nature: central (due to brain injury) and peripheral (due to damage to the chest).Death in this combination damage usually occurs during concomitant severe trauma (bruise and crush injury) of the brain and lungs.
combination injuries of the skull and pelvis bones also refers to serious polytrauma.their mechanism in most cases combined (by means of transport) - there is a primary blow to the pelvis, and then following it - a header in the fall.Depending on the location of the impact (front or rear) having fractures of the facial or cranial.
- Treatment of combined traumatic brain injury
- Combined traumatic brain injury (symptoms, first aid)
- damage the spinal cord and cauda equina
- Combined and multiple trauma of the spine
- Trauma skullin fractures of the spine
combination damaged skull and internal organs of the abdomen observed in 28.5% of patients.
Among these combinations without pelvic injury deaths is not observed, while the combination of «skull + abdominal organs and pelvis» dies every third.The main cause of death are related severe chest trauma, pelvis and lower extremities.
average hospital stay in surviving patients is on average 52 (15 to 165 days).Large length of stay of patients in hospital are associated with severe concomitant injuries of the lower limbs.Checking the long-term results shows that the return to the previous 50% in terms of victims from 2 to 7 years, 19.3% of patients continue treatment for 3 years, including a neurologist and psychiatrist, 15.1% of disability.