Nursing with obvious swelling

Craniocerebral injury (CCI) - mechanical damage to the skull and brain, vessels, cranial nerves, meninges.

There are craniocerebral trauma closed (concussion, bruise, compression), in which there are no conditions for infection of the brain and its membranes, and open. accompanied by an almost inevitable microbialpollution and always thawing danger of infectious complications from the meninges (brain meningitis) and the brain (abscesses, encephalitis). If it is accompanied by a violation of the integrity of the dura mater, it is called penetrating.

Etiology: the most common causes are traffic accidents, falls, punch, industrial, sports and domestic injuries.

Shake the brain develops more often with closed craniocerebral trauma.

The concussion of the brain is usually manifestedloss of consciousness of varying duration, from a few moments to several hours, depending on the severity of the concussion. After exiting the unconscious state, headache, nausea, sometimes vomiting, dizziness, the victim almost always does not remember the circumstances preceding the trauma, and the very moment of it (retrograde amnesia). Pimple or redness of the face, increased heart rate, general weakness, increased sweating. All these symptoms gradually disappear, usually in 1-2 weeks.

The first first aid for a patient with a concussion: lay the victim with a turned and raised head, apply cold to the head, call an ambulance brigade, monitor the patient's condition (blood pressure, pulse, pupillary response, consciousness).

Ushibom the brain is called local damagebrain substance - from a minor, causing in the affected area of ​​the brain only minor hemorrhages and edema, to the most severe, with rupture and crushing of the brain tissue.

A bruise of the brain is possible with an opencraniocerebral trauma, when the brain is damaged by fragments of the bones of the skull. The bruise of the brain, like a concussion, is immediate, but lasting - up to several hours, days and even weeks, loss of consciousness. With light bruises of the brain, motor, sensitive and other disorders usually completely disappear within 2-3 weeks. With heavier bruises, persistent consequences remain: paresis and paralysis, sensitive disorders, speech disorders, epileptic seizures.

Providing the first pre-medical care is needed,injured person to lay on his side, clean the mouth of vomit remnants, apply cold to the head, call an ambulance brigade, transport to neurosurgical or traumatic discharge, controlling all vital signs.

Compression the brain can be caused by intracraniala hemorrhage, a depression of a bone at a fracture of a skull, an edema of a brain. Signs of compression of the brain at TBI are increased headaches, anxiety of the patient or, conversely, drowsiness, appear and gradually increase focal disorders, the same as with a bruised brain. Then comes a loss of consciousness, life-threatening violations of cardiac activity and respiration occur.

Diagnosis of injury based on examination, evaluation of symptoms, radiography in two projections, CTG, MRI, spinal puncture, evaluation of neurological status.

Patients with mild trauma shouldhospitalized for follow-up at 3-7 days. The main goal of hospitalization is not to miss a more serious injury. In the future, the probability of complications (intracranial hematoma) is significantly reduced, and the patient can be observed out-patient, but if the condition worsens, he will be quickly taken to the hospital.

Treatment is reduced only to symptomatic help. When pain is prescribed analgesics, with pronounced vegetative dysfunction - beta-blockers and bellataminal, with sleep disturbance - benzodiazepines. Patients who underwent a lung injury are often prescribed nootropic drugs - piracetam at 1.6-3.6 g / day, pyrithinol (encephabol) at 300-600 mg / day, cerebrolysin 5-10 ml intravenously, glycine 300 mg / day under the tongue . In the presence of a wound, it is audited, processed, antibacterial agents are prescribed, and tetanus prophylaxis is performed.

Treatment of severe TBT is mainly to prevent secondary brain damage and includes the following measures:

1) maintenance of airway patency(cleansing from the mucus of the mouth and upper respiratory tract, the introduction of the duct, the imposition of a tracheostomy). With moderate stunning, in the absence of breathing disorders, oxygen is prescribed through a mask or nasal catheter.

2) stabilization of hemodynamics, with a significant increase in blood pressure prescribed antihypertensives.

3) if a hematoma is suspected, an immediate consultation with a neurosurgeon is indicated;

4) prevention and treatment of intracranial hypertension - the administration of mannitol and other osmotic diuretics (lasix);

5) with pronounced excitation, sodium oxybutyrate, haloperidod;

6) for epileptic seizures, relanium is injected intravenously (2 ml of a 0.5% solution intravenously), after which immediately antiepileptic drugs are prescribed inside (carbamazepine, 600 mg / day);

7) the patient's diet (via a nasogastric tube) is usually started on the 2nd day;

8) antibiotics are prescribed for the development of meningitis or prophylactically with an open craniocerebral trauma (especially with a liquor fistula);

9) surgical intervention consists in trepanation of the skull, lumbar puncture.