Cerebral edema clinical manifestations of acute care
Traumas of the skull and brain occur whendirect impact on the head, the type of acceleration (road accidents falling from a height), with the head squeezed between two solid objects. Depending on the severity of the trauma agent in the brain, either reversible (concussion) or irreversible changes (bruises of different degrees) occur. Of great importance is the formation of intracranial hematomas and foci of brain crushing, which, in the absence of specialized neurosurgical care, leads to an increase in cerebral edema, the development of dislocation and, consequently, death. For practical work, it is advisable to allocate three degrees of craniocerebral trauma at a prehospital stage: mild, moderate and severe.
Light craniocerebral injury (concussion, bruise of the brain of mild degree).
Symptoms. Characterization of deenergizing of consciousness on severalminutes, some confusion, disorientation after recovery, retro and anterograde amnesia Vomiting is often observed. Patients complain of severe headache, general weakness, dizziness, noise in the ears, pain in the eyeballs. Focal neurological symptoms are slight or absent.
Urgent care. Immediately at the scene of the patient needlay on your back or on your side. Transportation is carried out only in a lying position. Patients are injected with analgesics (2 ml of 50% analgin solution in / m), decongestants (20-40 mg of lasix w / m), 20 ml of 40% glucose solution IV.
Before establishing a clinical diagnosis or examinationpatient neuropathologist or neurosurgeon should not use sedatives to stop possible excitation, as these drugs can affect the manifestation of focal and cerebral symptoms, which can lead to diagnostic errors. In the presence of wounds on the head of the patients, it is necessary to carry out the wound treatment, stop the bleeding, apply an aseptic bandage.
Hospitalization is carried out in traumatological, neurological, general surgical hospital.
Craniocerebral injury of moderate severity (brain contusion of medium degree).
Symptoms. These victims are characterized by morea long switch off of consciousness - from several minutes to several hours. Expressed retro and anterograde amnesia, patients are disoriented in time and place, somewhat inhibited. Complaints of a diffuse headache. Meningeal symptoms are moderately expressed, possibly psychomotor agitation. Focal neurological symptoms that correspond to the localization of the brain contusion are identified (inadequate coordination coordination behavior, pyramidal symptoms, speech disorders, nystagmus, anisocoria, etc.). In the radial patients, there are damages to the bones of the arch and the base of the skull, which are manifested by pronounced narrophenic hematomas, hematomas in the region of the mastoid processes (in the case of a fracture of the temporal bone pyramid), in the orbit (symptom of "points" - in the fracture in the anterior cranial fossa) blood with an admixture of liquor from the nose, ear, at the back wall of the pharynx, to determine the presence of cerebrospinal fluid in the blood use a simple method of "double stain" when the blood is extracted from the nose or ear. In the diagnostic plan, it should be noted that the craniocerebral injury with the presence of liquorrhea is considered open.
Urgent care. Same as with a slight craniocerebral trauma.
Hospitalization. urgently to a neurosurgical hospital.
Severe craniocerebral trauma (severe brain contusion).
Symptoms. Characterized by a long shutdown of consciousnessviolation of the respiratory and cardiovascular systems. Tachycardia or bradycardia arterial hypertension is the difficulty of breathing which is caused both by a violation of the patency of the airways and by the primary suffering of the corresponding brain stem departments. In the first hours after the injury, primary-stem neurological symptoms predominate (floating movements of eyeballs, breathing disorders, bilateral narrowing or dilating pupils, changing muscle tone, decerebrate rigidity, inhibition of deep reflexes), cerebral (oppression of consciousness to sopor-coma). Severe craniocerebral trauma, as a rule, is accompanied by a fracture of the arch and base of the skull, as well as massive subarachnoid hemorrhage.
Urgent care. Medical activities are directed mainlythe correction vital disturbances (introduction duct, intubation, mechanical ventilation) administering plasma-solution (400 ml poliglyukina, reoglyumana, rotsdeksa) degtsdratatsionnyh medications (Lasix 40-80 mg / m or / in to 100 mg of hydrocortisone or 1000 mg of prednisolone IV). Often, patients are in a state of intoxication, which largely changes the clinical manifestations of traumatic brain injury. In such cases, the administration of 5-10 ml of a 05% solution of bemegrid IV is indicated. Sedation therapy should be avoided.
Hospitalization. in an emergency in the neurosurgicalhospital. With pronounced violations of vital functions, the patient's transportation possibilities are limited, and the victim is hospitalized in the nearest intensive care unit.
Severe craniocerebral injury with compression of the brain (intracranial hematomas, depressed fractures, foci of crushing of the brain, etc.).
Symptoms. For victims with intracranial hematomacharacterized by a light period after the injury, after which their condition progressively worsens, consciousness becomes depressed, signs of cerebral compression appear (bradycardia up to 40-50 beats per minute, unilateral mydriasis, accruing or persistent contralateral hemiparesis, bilateral pathological stop signs, focal or generalized convulsive seizures etc.). Depending on the type of hematoma (epi- or subdural), this clinical picture can develop at different times after the trauma - from several hours (with epidural hematoma) to several days and even weeks (with subdural). Prehospital diagnosis of intracerebral hematoma, foci of brain crushing is extremely difficult; the clinical picture corresponds to brain contusion of severe degree with prevalence of hypertensive-dislocation syndromes.
Urgent care. Measures are carried out to correct the vitaldisorders to prevent the development of progressive edema and dislocation of the brain (see severe craniocerebral injury). With wounds and compressed fractures of the bones of the cranial vault, after careful, gentle treatment, an aseptic dressing is applied with the use of a cotton-gauze "bagel" (to prevent further insertion of bone fragments and damage to the brain substance).
Hospitalization. urgently in neurosurgical hospital, as these victims shown emergency surgery for health reasons.