Algorithm for helping with chmt. First aid for traumatic brain injury

Some even tried to provide emergency care at the prehospital stage. First aid for traumatic brain injury and its timing play a leading role in the structure of first aid (PMP). Very often, the negative consequences and complications of TBI are not only a consequence of the very extent of the injury, but also arise from improper and untimely medical care.

With a head injury, the bones of the skull and soft tissues are damaged - the brain, its membrane, blood vessels. Trauma has a variety of clinical symptoms, and even experienced trauma doctors cannot always adequately assess its severity.

Medical attention is not always sought for with a head injury. This mainly happens if the patient loses consciousness. If TBI is mild and there are practically no signs of a pathological process, then the victim does not pay due attention to the head injury. This is a mistake, since even mild TBI without proper examination and treatment can have negative consequences in the future.

Some diseases caused by trauma have a prodromal or light period. After receiving an injury, after a while the patient becomes better, all symptoms disappear, the patient feels absolutely healthy. But this is an imaginary well-being, after a few hours or days the symptoms return and the victim's condition worsens. This clinic is typical for subdural hematoma.

To correctly provide emergency care and not harm the patient, you should know the classification of TBI, be able to correctly and timely determine the presence of head injury and have some general skills in providing care at the prehospital stage.

Classification

Head injuries are classified based on the presence of a penetrating wound:

1. Open traumatic brain injury (TBI).
2. Closed craniocerebral injury (CCI).

According to the severity of the course of the disease, there are:

Also, head injuries are characterized by the type of damage:

1. Concussion is a reversible process, characterized by a local lesion of the gray matter.
2. Brain contusion - with this type of injury, focal brain damage is formed, pathological changes can be reversible or not. It is also subdivided into 3 categories according to severity;
3. Compression of the brain due to the formation of hematomas - clinical symptoms and the severity of the course depend on the type, size and location of the hematoma, sometimes the process develops into a chronic one;
4. Compression of the head, as the name implies, occurs due to compression of the head by external forces, as a rule, the damage occurs with other injuries;
5. Diffuse damage to axons is a special type of pathological process in which the brain substance, or rather, its conducting system, suffers.

These characteristics play a leading role in the algorithm for the provision of emergency care at the prehospital and hospital stages.

In the modern world, almost all educational institutions of different levels of accreditation have introduced lessons aimed at developing practical skills in providing emergency care at the prehospital stage, including TBI. This allows not only to increase the level of theoretical knowledge, but also to acquire practical skills in PMP.

TBI symptoms

Diagnosis of an open craniocerebral injury does not cause any particular difficulties. Even if the penetrating wound is small and scalped, the presence of an open wound automatically counts it as TBI. Diagnosis of a closed TBI is much more difficult.

The main signs of a closed head injury are loss of consciousness from 3-4 minutes, dizziness, severe bursting headache, which may be accompanied by nausea or even vomiting, impaired consciousness in the form of stupor, stupor. Sometimes the victim has a memory impairment. It goes in two types:

• the patient forgets the moment of injury and the events that preceded it (retrograde amnesia)
• the patient does not remember what happens to him after the injury.

A patient with TBI is lethargic, passive, he is sleepy. With severe head injuries, the patient may have a speech disorder: he answers inappropriately, confuses words, speech is sluggish. The patient himself, as a rule, is not aware of these signs. In extremely severe cases, vital functions are impaired, which, without timely emergency care at the pre-hospital stage, can lead to the death of the victim.

Urgent Care

Regardless of the general condition of the patient and the severity of symptoms, first aid for traumatic brain injury includes the following actions:

1. The victim should be laid on his back, preferably on a flat, hard surface, no pillows or bolsters.
2. If the patient is unconscious, turning his head to the side is the prevention of aspiration of vomit at the pre-hospital stage. It also prevents the tongue from blocking the oxygen supply to the lungs.

If at the time of injury the victim was fixed by something, for example, in an accident he was pressed by the door, do not try to free him yourself, as this can cause additional damage.

1. If there is an open wound on the head, a bandage should be applied. The edges of the wound are covered with bandages, if possible, moistened with saline, and then the bandage itself is applied. It should be tight enough, pressing enough to stop bleeding, but at the same time to minimize trauma to the already damaged tissue, its second task is to prevent infection from entering the wound.
2. Another way to stop bleeding is finger pressure. After the bleeding has stopped or has significantly decreased, a pressure bandage with a roller is applied to the head.
3. If there was a first-aid kit at hand, you can immobilize the victim's head with a special collar, but this must be done with extreme caution.

Victims with TBI who are not critical to their condition require hospital monitoring.

Call the ambulance. Describe the victim's condition to them, perhaps the dispatcher will suggest an algorithm for actions at the prehospital stage.

Indications for hospitalization of the victim:

• the presence of a wound requiring suture;
• severe external bleeding, as well as bleeding from the nose and ears;
• loss of consciousness;
• severe headache, nausea, repeated vomiting;
• violation of consciousness;
• cramps or severe weakness in the limbs;
• speech disorders;
• lack of spontaneous breathing and heartbeat.

The main mistakes in providing emergency care

When providing emergency care for TBI at the prehospital stage, an inexperienced person can get confused and make several gross mistakes. You can't:

• to seat the victim;
• jerk or lift the victim to his feet;
• leave unattended.

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First aid. With any TBI at the scene, one should first of all determine the nature of the injury, the presence of consciousness, spontaneous breathing, heartbeat, and in accordance with this, carry out the necessary measures to provide assistance.

The algorithm for providing first-aid emergency care for TBI is as follows.

With an open injury:

1. Apply an aseptic bandage; with swelling of the medulla, the standing of bone fragments - with a "donut".
2. Release the collar from the victim's neck.
3. Remove foreign bodies (knocked out teeth, blood clots, mucus, etc.) from the oropharynx with a finger wrapped in a gauze cloth; ensure the patency of the airways (enter the air duct, perform the triple reception of Safar).
4. Perform closed heart massage (CMC) and mechanical ventilation (IVL) (mouth-to-mouth, mouth-to-nose) if necessary. For a fracture of the base of the skull:
5. Make a light tamponade (without violence!) Of the nasal passages, external auditory canal.
6. On command, transfer the victim to the stretcher on his back, raise his head by 10 ° and fix it using Kramer's splint, “donut”, Elansky's splint, etc .; if the victim is unconscious, he is placed on his stomach or in a stable lateral position to prevent asphyxiation.
7. Carry out the simplest anti-shock measures.
8. Apply cold to the head.
9. Ensure airway patency during transportation; register Ps, NPV, blood pressure every 10 min.
10. Transport the victim to the neurosurgical department of the hospital.

Note. It is forbidden to carry out manipulations on a brain wound! It is forbidden to use manual ventilation techniques, as they can increase intracranial bleeding!

V. Dmitrieva, A. Koshelev, A. Teplova

"First aid for traumatic brain injury" and other articles from the section General surgery

About first aid for traumatic brain injury (TBI)

The brain is the "control center" of all human life support systems. Any injuries associated with blows, bruises or wounds to the head area cause poor blood supply to the brain cells and cause dysfunction.

Traumatic brain injury is a head injury, in which the integrity of the bones and skin of the skull and the functioning of the brain are disrupted. Such violations are always accompanied by characteristic symptoms of a neurotic nature. For traumatic brain injury, first aid helps prevent serious consequences of the injury, facilitating the period of treatment and recovery. Sometimes the timely intervention of doctors saves the patient's life.

Skull lesions and their characteristics

The causes of this type of injury are mechanical effects on the cranial vaults. The main provocateurs of TBI are the following factors:

• Traffic accidents and other accidents involving transport;
• Injury at work;
• Household damage;
• Fall from a height, as a result of which the head area is injured.

It is important to know that the specificity of trauma manifestations is determined by the severity of TBI, as well as its type. Sometimes the symptoms are so nonspecific that making a diagnosis without appropriate diagnosis is also difficult for experienced physicians. Due to the frequent latent ("light") periods when the patient feels relief due to the stopped symptoms, many people who are injured do not want to see a doctor. However, this is a big mistake. After 2-3 hours, a concussion of the brain again makes itself felt with a sharp deterioration in well-being.

To figure out what first aid to provide for a scalp injury, you need to clearly distinguish between the types of concussions.

The presence or absence of changes in the integrity of muscle and bone tissue distinguish 3 types of TBI:

1. Closed craniocerebral injury;
2. Open damage to the skull;
3. Penetrating damage.

First you need to figure out what a closed head injury is. Statistics show that closed-type injuries are most common. They affect exclusively the integument of the skin, preserving the integrity of the aponeurosis. This type of injury often presents with a concussion, symptoms of which are unconsciousness and amnesia.

An open TBI is easy to recognize: it is accompanied by serious damage to the skin integument with the participation of aponeurosis. Injury to bone and gray matter is possible.

With penetrating damage, the lining of the brain is directly injured.

Features of providing first aid for head injuries also depend on the type of injury. This characteristic of TBI is considered prevalent, with specific symptoms and condition of the victim.

Let's consider the manifestations of each of them, highlighting the characteristic symptoms.

Shake

Considering that pathologies of the macrostructural plan are not recorded with it, concussion is a reversible process: damage affects only the cellular level. Instrumental examination (CT and MRI) of abnormalities is not recorded.

• Loss of consciousness, the duration of which does not exceed 2-3 minutes or only a few seconds;
• Short-term memory loss;
• Development of nausea, turning into vomiting.

After regaining consciousness, the patient experiences dizziness, a headache "spreading" over the entire head area, excessive sweating. Possible short-term visual impairment, manifested by double vision or flashing "flies".

With a timely PMP, the main symptoms that this brain injury causes disappear within 6-8 days.

In case of a brain injury, serious macrostructural changes in the medulla are clearly recorded, the manifestations of which are hemorrhage and destruction. Often they are accompanied by a fracture of the base of the skull, which causes numerous hemorrhages.

The victim's condition is characterized by the severity of these two interrelated factors. The peculiarities of their manifestation make it possible to divide brain contusions into 3 groups. It can be mild, moderate, or severe.

1. Light degree.

Lack of consciousness lasts no more than 20 minutes. After a person comes to his senses, characteristic symptoms appear:

• Vomiting;
• Dizziness;
• Memory loss;
• Bradycardia;
• Trembling hands and chin;
• Tiptoeing;
• Hypertension;
• Headache "spread" over the entire head area;
• Involuntary, repetitive eye movements;
• The manifestation of pyramidal insufficiency is possible.

Lack of consciousness is recorded for more than 3 hours. Upon recovering, the patient suffers from excruciating bouts of vomiting. There are obvious mental disorders and deep memory gaps.

Symptoms are pronounced:

• Significant excess of blood pressure indicators;
• Weak heartbeat;
• Throwing back the head;
• Manifestations of uneven distribution of muscle tone;
• Inability to move limbs;
• Speech disorders.

The lack of consciousness continues for weeks, it can go up to 1 month. Depression of respiratory and circulatory functions is recorded, which can lead to the death of the patient. The patient falls into a coma, which is manifested by the following signs:

• Floating eyeballs;
• Immobilization of the limbs;
• Attacks of convulsive contractions.

Compression

The pressure on the brain occurs under the influence of hematomas, which are located above the brain. Their development is triggered by fractured skull bones. Symptoms of compression are the same as in case of a brain injury. However, the pressure of hematomas has an important feature: the presence of a "light" period, when all the signs disappear and the patient feels absolutely healthy.

However, rapid brain edema, accompanied by an increase in its volume, again leads to a coma.

Regardless of the type and extent of injuries one has to face, after providing first aid for head injuries, you should immediately contact a health care facility for a complete examination and appropriate treatment.

Specificity of emergency measures before hospitalization

In traumatic brain injury, emergency care consists in the application of observation techniques, recording indicators important for maintaining a person's life, and resuscitation actions, if necessary. The main task of the rescuer is to maintain the functioning of the patient's important organs and systems.

With TBI, an immediate call to the medical team is made if the patient has one of the following symptoms:

• Respiratory and circulatory disorders;
• Continuous bleeding from the wound;
• Bleeding from the ears and nose;
• Being unconscious for more than 30 seconds;
• Intolerable headache;
• Unclear consciousness;
• Loss of balance and orientation;
• Recurrent convulsive syndrome;
• Incessant vomiting;
• Inability to move an arm or leg;
• Slurred speech.

The presence of an open skull injury requires immediate hospitalization!

During the conversation with the ambulance dispatcher, describe in detail the condition of the victim, the presence or absence of bleeding.

The algorithm for providing emergency care is fast and consistent actions:

1. The patient is placed on a flat hard surface.
2. Examine the site of injury to determine the type and nature of the injury.
3. Determine the stability of the heart and lungs by measuring the pulse and monitoring breathing.
4. If a person is in deep fainting, his body is turned on its side to avoid the penetration of vomit into the esophagus and the retraction of the tongue.
5. If the patient has an open head wound, dressing and disinfection are prerequisites for first aid in traumatic brain injury. Before the arrival of doctors, the wound (its edges) must be treated with a disinfectant solution to prevent the occurrence of infections. For this, the edges of the damaged area of \u200b\u200bthe head are first covered with soft bandages, and then the bandage itself is used. It should be tight enough to stop bleeding, but not so tight that soft tissue is compressed.
6. Apply cold to the injured part of the head.
7. Immobilize the neck by covering it with rollers.
8. If necessary, resuscitation first aid is provided: indirect heart massage and artificial respiration.

Before the arrival of medical personnel, one must not leave the scene of the incident: at any moment, a person may again fall into unconsciousness.

In case of traumatic brain injury, accompanied by injury, first aid is provided according to the same principle as with an open form of injury.

Important information

Help with a head injury does not require special skills, but an inexperienced person can get confused, especially if there is a lot of blood loss due to damage to the skull. Therefore, it is important for the rescuer to stop panicking and follow the instructions above clearly. Moreover, the mistakes made can cause serious consequences of traumatic brain injury, only aggravating the condition of the victim.

We list the actions that are prohibited from performing at the stage before hospitalization:

• Try to seat the patient;
• Move the victim, dramatically changing his posture;
• Offer the patient medication or food;
• Leave a person alone until the arrival of doctors;
• Independently try to straighten bone fragments sticking out of the wound;
• Remove foreign objects from the wound.

The victim must be examined by doctors. After this, the person is hospitalized. The doctor warns the patient about the possible consequences of serious injury if he refuses to go to the hospital.

Treatment of traumatic brain injury is selected taking into account the degree and type of injury. Most often, therapy consists of actions aimed at improving cerebral circulation and preventing cerebral edema. Strict adherence to bed rest and complete rest is mandatory. For this purpose, sedatives are prescribed.

In severe forms of TBI, treatment consists in emergency surgery, with the help of which accumulated hematomas are removed.

Remember that in case of head injury, the lack of timely assistance is fatal in 70% of cases. Moreover, failure to act in such a situation provides for criminal punishment.

Remember! Emergency calls are free! Ambulance phones are valid throughout the Russian Federation!

Calling an ambulance from city phones - 103 (03)

To call emergency services from a mobile (cellular) phone, the number 112 works.

In Russian and English.

Calling from number 112 is possible:

In the absence of funds in your account;

With a locked SIM card

If there is no SIM card in the phone

If your mobile device does not support two-digit dialing, when calling emergency services, after the service number, you must dial *

Ambulance - 03 *

Additional phones for calling the ambulance of mobile operators:

MTS - 030, Megafon - 030, Beeline - 003, Sky - Link - 903, Tele2- 030, U-tel - 030, Motive - 903.

First aid for traumatic brain injury

The human brain is better protected than any other human organ. This organ is washed with a special fluid that performs 2 functions:

1. Serves as a source of additional power.
2. Acts as a kind of shock absorber.

In addition to this fluid, the brain has several protective membranes, as well as the cranium. Despite so many protective shells, head trauma causes brain problems.

Traumatic brain injuries are divided into 2 groups:

• open. They are characterized by damage to all soft tissues of the head (epidermis, subcutaneous tissue, various fascia, bones of the skull).
• closed. Less dangerous injuries. The most common closed injury is concussion.

Causes of injury

Injuries are usually the result of strong blows, sudden head movements, and bruises. Most often, head injury occurs in major traffic accidents. Sometimes injuries occur in everyday life, during sports, at work.

With very strong blows to the head, craniocerebral injuries occur, accompanied by damage to the bones of the skull, intracranial structures. The causes of such damage are impacts from falling from a height, in case of an accident.

Damage symptoms

Because of its pronounced symptoms, an open head injury is very easy to recognize. But with the recognition of a closed damage, everything is much more complicated. The main symptoms of a dangerous traumatic brain injury are:

• sudden loss of consciousness (in some cases);
• the presence of severe headache;
• manifestation of general weakness;
• nausea, profuse vomiting;
• manifestation of drowsiness;
• amnesia. The injured person forgets the event that caused the injury or the events that preceded it.

As a result of a severe form of traumatic brain injury, a person experiences loss of consciousness. Consciousness after such damage may be absent for a long time. Development of paralysis is also possible.

Among the external symptoms of traumatic brain injury are:

• scalp damage;
• manifestation of seizures;
• bone fractures that are visible;
• neck tension;
• the presence of edema, abrasions on the head;
• throwing the head back;
• discharge from the nose of blood, cerebrospinal fluid;
• twitching of the eyeballs when looking to the side;
• there is an unequal expansion of the pupils;
• bruising around the eyeballs;
• when probing, the pulse is slowed down;
• increased body temperature;
• the victim's breathing becomes noisy, intermittent.

When examined in a medical institution, the patient may find additional symptoms of traumatic brain injury, which are divided into:

1. Mental disorders. Among them are psychotic states, affective, volitional, intellectual-mnestic disorders, paroxysmal syndrome.
2. Disorders of consciousness. The victim may be in a clear consciousness or in a state of moderate, deep stunning, moderate, deep, terminal coma, pathological drowsiness.

The main types of injuries

The main types of traumatic brain injury include:

• brain concussion;
• contusion (contusion);
• compression of the brain;
• fracture of the base, vault of the skull.

Concussion

This type of TBI is considered the least severe injury. With a concussion of the brain, there are practically no organic changes inside the brain tissue. Typical symptoms of this damage are:

• Loss of consciousness;
• Loss of memory for a small period of time;
• Nausea;
• Dizziness;
• General weakness;
• Vomiting;
• Headache.

All symptoms usually return to normal within 1 to 2 weeks.

Contusion

This type of TBI is in second place in terms of severity (if counting from less dangerous). With such an injury, foci of damage are observed inside the brain tissue. Concussion symptoms are accompanied by the presence of focal symptoms:

• Limb paralysis;
• Hearing impairment, vision;
• Impaired speech.

Concussion symptoms are more pronounced. The appearance of a difference in the size of the pupils is also observed.

Compression of the brain

As a result of this trauma, the patient develops subdural, epidural, and intracerebral hematomas. This injury develops as a result of ruptured blood vessels. Blood flowing out of the injured vessel accumulates inside the cranial cavity. Because of this, some areas of the brain are compressed.

With the development of such an injury, the victim is observed:

• Depression of consciousness;
• Headache from the side of the injury;
• Drowsiness;
• Vomiting;
• Coma is sometimes possible;
• Unilateral pupil dilation is noted.

Fracture of the base, vault of the skull

TBI can be accompanied by bone fracture. Fractures of the cranial vault are of 2 types:

• Linear. This type is formed as a result of an impact with a large contact area;
• Impressed. Occurs when there is a small contact area. In this case, the immersion of a bone fragment into the cranial cavity is observed.

A symptom of a base fracture is the presence of a pair of orbital hematoma. Also, the patient has a leakage of ichor, cerebrospinal fluid from the ears, nose. The victim also has a teapot symptom. It manifests itself in the fact that when leaning forward, the outflow of fluid from the nose increases, and when leaning to the side - from the ear.

This type of TBI is dangerous because the likelihood of infection of the cranial cavity through the nasopharynx, middle ear, and paranasal sinuses increases. Abscesses and meningitis may occur inside the cranial cavity. Also, the consequences of such damage are: facial asymmetry, impaired hearing, smell, vision.

Diagnostics

Among the diagnostic measures aimed at detecting, the study of traumatic brain injury are:

• examination by a neurologist. Essential for diagnosing a concussion;
• x-ray examination of the skull. It is necessary to determine a bone fracture;
• echoEG. It is performed to detect an asymmetric formation inside the skull;
• ophthalmoscopy. Determines the presence of stagnant discs;
• UT. Determines the presence of hematoma, lesions;

First aid

When determining a traumatic brain injury in a victim, assistance should be provided immediately. Every minute counts. When starting to provide first aid for traumatic brain injury, one should remember about the possible consequences after improper actions. The transportation of the victim with TBI should be performed by doctors. The first aid algorithm is represented by the following actions:

1. It is necessary to ensure that the victim lies on his back. You should constantly monitor the general condition of the patient (monitor his pulse, breathing).
2. If the victim is unconscious, he must be placed exclusively on his side. This position helps to prevent suffocation, vomit entering the respiratory tract. Lying on its side eliminates the likelihood that the tongue will sink and suffocation will occur.
3. If there is an open wound, a sterile dressing should be applied.
4. If the victim has an open craniocerebral injury, then when providing first aid, sterile bandages should be applied to all the edges of the wound. After completing this step, you should adjust the main bandage.

First aid for traumatic brain injury consists in performing the listed actions. After that, you need to urgently call an ambulance for transportation to the medical center, to provide further medical assistance to the victim. You cannot do without the help of specialists in such cases:

1. With profuse bleeding from a wound with an open head injury.
2. With profuse bleeding from the nose, ears.
3. In the complete absence of signs of breathing.
4. With severe headache.
5. In the presence of complete loss of consciousness (if this state lasts more than a few seconds).
6. If the victim has confusion.
7. With the manifestation of severe weakness in the upper, lower extremities. Limb immobilization is sometimes observed.
8. When the usual balance is disturbed.
9. With the manifestation of indistinctness in the speech of the victim.
10. If you have severe seizures.
11. With repeated profuse vomiting.

It is also obligatory to call an ambulance if the victim has an open craniocerebral injury. Despite the good health of the patient, he should seek medical help from specialists. After all, the consequences of trauma can manifest themselves much later.

Prohibited actions when traumatic brain injury is detected

Since it is impossible to transport a patient from TBI, first aid should be provided on the spot. Providing first aid to a victim with a traumatic brain injury is mandatory in the first minutes. It is important to remember that there are actions, the implementation of which can lead to irreparable complications. So when providing emergency medical care, it is strictly forbidden:

Treatment

TBI treatment is influenced by the severity and nature of the injury. The life of the victim is threatened by an acute period of injury. At this time, a complex of emergency measures is used to treat the patient. They usually take about 2 hours to complete after the victim is admitted to a medical facility.

Treatment of damage in the acute period consists in performing actions aimed at:

• ensuring patency in the upper respiratory tract;
• provision of artificial ventilation;
• anti-shock therapy;
• stabilization of hemodynamics;
• maintaining blood pressure;
• regulation of water balance;
• tracking body temperature.

Also, during this period, it is necessary to perform antibiotic therapy. Specialists prescribe symptomatic medication, surgical treatment. After the patient's consciousness is restored, he is prescribed activating therapy.

Among the main tasks of doctors are:

• maintaining normal intracranial pressure;
• protection from hypoxia of the cerebral cortex;
• actions aimed at preventing damage to brain tissue.

The brain is a high-tech mechanism that can only be compared with a powerful computer.

It is equipped with a multi-core processor, large RAM, and a hard drive that can multitask, store tons of information and keep the whole body alive.

Therefore, it is so important to monitor its safety, because human life depends on it.

• All information on the site is for informational purposes only and IS NOT a guide to action!
• Give an EXACT DIAGNOSIS you can only a DOCTOR!
• We earnestly ask you NOT to self-medicate, but make an appointment with a specialist!
• Health to you and your loved ones!

TBI is a complex head injury (soft tissues, bones of the skull, brain), accompanied by characteristic neuropathologies.

The ability to recognize and provide timely medical assistance may be needed completely unexpectedly - on a hike, a trip out of town or a household street fight. Therefore, the algorithm of actions should be known to everyone, because your knowledge can save a person.

Causes

The most common culprits of TBI are:

• accidents and road accidents;
• production damage;
• injuries sustained during sports training;
• household injuries;
• fall from a height, accompanied by head and neck trauma.

How to recognize a TBI

TBI can be judged by the presence of external injuries and characteristic neuropathological symptoms.

A well-known symptom of TBI is a temporary blackout (from 5-10 seconds to several hours and even coma).

If you witness an accident (especially involving a child), try to remember how quickly the victim reacted to the pain. If the person reacted immediately (for example, screamed), there was no blackout.

Confusion, dimness of consciousness, gaps in memory should alert: the victim looks stunned and confused, does not realize where he is now, cannot name himself, describe what happened, where he was going, does not recognize loved ones.

With TBI, the cranial nerves, which are responsible for smell, taste, swallowing, balance, hearing, vision, facial expressions, and so on, are affected.

Therefore, it is necessary to closely monitor the condition of the victim - if a violation of one or more functions is noticeable, first aid should be immediately provided for traumatic brain injury.

The most indicative is the reaction of the pupils, for example, to the beam of a flashlight. Pupils may respond sluggishly or not respond at all to a beam of light, this is due to the severity of TBI. The lack of reaction of one pupil should be especially alarming.

Symptoms are differentiated by the type of TBI.

The most common type of head injury (about 80%) is concussion. Concussion does not provoke irreversible consequences and after a week there are no traces of pathologies.

Concussion is accompanied by:

• blackout (for a few seconds or a few minutes);
• feeling;
• nausea, vomiting;
• memory loss;
• disorder of visual functions (fuzzy image, its bifurcation, black dots in front of the eyes);
• asymmetry of tendon and muscle reflexes.

Is another type of head injury. It is accompanied by severe macrostructural damage to the GM body, polytrauma of the cranial bones.

Depending on the manifestation of clinical symptoms, it can be mild, moderate and severe:

A slight bruise of the GM is accompanied by:	loss of consciousness (about 20 minutes); dizziness; nausea, vomiting; headache; partial memory impairment; bradycardia (slow heartbeat); hypertension (increased blood pressure); anisocoria (asymmetric pupil response); insufficiency of pyramidal structures (tremor of the hands, trembling of the chin, walking on tiptoes, impaired grasping reflex); nystagmus (repeated involuntary eye movement)
Brain contusion of moderate severity is characterized by:	loss of consciousness (lasting for several hours); repeated urge and vomiting; obvious loss of memory; respiratory failure, even if there is no damage and airway patency is not impaired; persistent bradycardia; hypertension; asymmetry of tendon reflexes and muscle tone, limb paralysis is possible; meningeal signs: immobility and tension of the occipital muscles, throwing the head back, Kernig's symptom (it is impossible to straighten the leg from a certain position at a right angle).
Severe brain contusion is accompanied by:	coma; disturbed breathing; mismatch of eye movements, they "float"; persistent dilation / constriction of the pupils, lack of response to a bright ray; hormone (increased muscle tone of the limbs in the form of seizures); paresis of the limbs; intracranial bleeding with the formation of hematomas.

With hemorrhages, intracranial hematomas are formed, causing compression of the GM. This happens in 3-5% of accidents.

Clinically manifests itself as a brain injury, but differs in the period of enlightenment of consciousness. After there is a progressive deterioration, and if the cause of the increased pressure is not removed surgically, this will lead to death.

First aid algorithm for traumatic brain injury

If you are a witness of a TBI accident, remember that the future health and even the life of the victim will depend on your timely, confident, coordinated actions. Therefore, the actions listed below are best remembered and trained to automatism in order to save precious minutes in a critical situation.

• firstly, it is urgently necessary to call an ambulance while the doctor drives to the scene, as far as possible to assess the condition of the injured person;
• find out whether the victim is conscious, if not, make attempts to bring him to his senses;
• determine the nature of the injuries received (open or if there are traces of bleeding, leakage of cerebrospinal fluid);
• check the heart rate and the presence of breathing, if necessary, do a resuscitating heart massage, artificial respiration;
• close open TBI with a sterile bandage, if protruding bone fragments interfere, apply a bandage around the perimeter of the wound;
• when the cerebrospinal fluid flows out, close the nasal and auditory canals with gauze tampons;
• if the victim is unconscious, make sure that the airways are free, remove foreign objects from the nasopharynx and oral cavity, lay the victim on his side;
• if the victim is conscious - place him on the ground in a prone position, fix his neck;
• apply a cold compress to the injury site;
• if emergency medical care is not available at the site of an emergency, you need to take care of the prompt delivery of the victim to a medical facility, while constantly monitoring the presence of breathing and heart rate, to ensure the maximum possible immobility of his body in a supine position.

What not to do

Some actions can worsen the patient's condition:

• the victim should not be allowed to sit down and get up, even if he says that everything is in order - confused, foggy consciousness in the first minutes after the emergency does not allow a person to adequately assess the situation, his condition;
• you cannot move the victim unless absolutely necessary;
• it is impossible to get fragments of bones, foreign objects from an open wound, so as not to cause even greater damage;
• it is impossible to leave a person with TBI unattended until doctors appear, since his condition may suddenly worsen at any minute;
• you cannot use narcotic analgesics until a doctor is examined, as this will lubricate the symptoms, cause an incorrect diagnosis and treatment.

Features of trauma in children and emergency treatment

In children, head injuries are mainly caused by falls from various heights and injuries sustained during sports training.

Children's skulls are more flexible than adults, and the brain tissue contains more water, which slightly softens the severity of the injuries. And the compensatory capabilities of the young organism are higher, which allows us to hope for a successful outcome.

If a child has a head injury in front of you, call an ambulance and try to assess the general condition. You should be alerted if you observe one or just a set of symptoms:

1. Disconnection of consciousness. It can be so short-lived that you might not notice it. Remember if there was a delay from the moment the child fell to his cry.
2. Nausea, vomiting, vomiting. They can appear both after an emergency and in a day.
3. Sleepiness, lethargy.
4. Sticky cold sweat, perspiration.
5. Disorder of consciousness, loss of memory.
6. Impaired coordination, lack of coordination of movements, tremor, asymmetry of muscle tone, loss of balance.

Before the arrival of the medical team, it is necessary to lay the child on a flat hard surface, fix the neck. If the child is unconscious, make sure that the airways are freely patented, lay the victim on his side to avoid asphyxiation with vomit.

In case of bleeding, it is imperative to use a sterile aseptic bandage, in case of liquorrhea - gauze or cotton swab in the nasal and ear passages. In the absence of a heartbeat or respiratory activity - carrying out resuscitating breathing, indirect heart stimulation before the arrival of medical assistance.

Remember, even if you think that the accident ended well, it is better for a specialist to determine the child's condition. If complications are suspected, the doctor will prescribe additional diagnostics (X-ray examination, magnetic resonance and computed tomography), which will help avoid delayed complications - hematomas and compression of the GM.

Until the child's final recovery, he is prescribed bed rest and the absence of harsh irritants (smells, sounds, light).

Craniocerebral injuries include both trauma to the bones of the skull and the contents of the cranium (brain, nerves, blood vessels, etc.). First aid for traumatic brain injury depends on the degree of damage.

Classification

The main types of traumatic brain injury are:

• contusion of the brain;

Symptoms

Signs of traumatic brain injury are divided into cerebral and focal.

The first occurs when the whole brain is damaged. The victim may lose consciousness for a few seconds, or maybe for a day. He may feel nauseous, disturbed by headache, dizziness, and painfully perceive noise and bright light. A person can even lose memory for a while.

If a specific area of \u200b\u200bthe brain is affected, the patient's functions are impaired, depending on what the damaged area is responsible for.

First aid for concussion

With a mild form of traumatic brain injury - concussion, first aid consists in treating the wound, applying an aseptic bandage, in strict bed rest, and monitoring the patient's breathing. If a person is unconscious, to avoid getting vomit into the respiratory tract, he must be laid on his side. Of course, you need to call an ambulance.

The peculiarity of a concussion is that the disorders it causes are reversible and disappear after a while.

First aid for bruising and compression of the brain

A brain injury is a severe head injury that is characterized by both concussion and significant damage to a specific area. With a mild degree of injury, a person loses consciousness for up to two hours, or he has lethargy, poor orientation in time and space, speech impairment.

With a moderate degree of such trauma, consciousness is lost for a longer time, up to several hours. The patient may have a decreased reaction of the pupils to light, develop shortness of breath, rise or fall in blood pressure. With a severe injury, a person can be unconscious for up to several weeks. He may have a convulsive seizure, change the rhythm of breathing.

When the brain is compressed, there is a concussion, and severe contusion, and compression of the brain by edema, bone fragments, or hematoma. In this case, a person can be conscious, but in an excited state. He has a headache, respiratory depression, and prolonged seizures are possible. At the same time, immediately after an injury, the victim may not feel any signs of it, and if left without help, this can adversely affect his health.

First aid for such types of traumatic brain injury as contusion and compression consists in stopping bleeding and treating the wound with a bandage, monitoring the victim's pulse and breathing and immediately calling an ambulance.

In order to stop the bleeding, you should firmly press a sterile tissue to the wound and hold it until the bleeding stops. If the victim does not have breathing and pulse, he will need artificial respiration and chest compressions. These measures must be carried out until the moment when the person's respiratory and cardiac activity is restored. Then you need to lay the victim on his side, cover and warm him.

General rules for first aid

It is important to know that in case of a head injury, the victim should not be in a sitting position and, moreover, should not stand. In the absence of obvious damage to the bones, ice in a cloth can be applied to the site of injury. In no case should bone fragments and foreign bodies be removed from the wound.

When providing first aid, you need to be very careful: do not make sudden movements, avoid pressure. When treating a wound and applying a bandage, medications and a sterile bandage should be used. If you do not follow these rules, an infection can enter the wound and then the brain, causing serious illness.

Yours faithfully,

3968 0

Victims with TBI (closed and open) require emergency medical care. Closed head injury is understood as damage in which there are no violations of the integrity of the skin and scalp (wounds). On the contrary, open head injury is characterized by the presence of damage to the skin and scalp (wounds).

In 1979, BA Samotokin proposed a classification of closed head injury. The following forms of closed TBI have been identified: concussion (without division into severity); mild, moderate and severe brain bruises and cerebral compression.

This section will also describe TBIs such as skull base fractures and open TBIs.

Brain concussion

This form of closed head injury is characterized by short-term loss of consciousness immediately after the injury. Sometimes consciousness can remain intact. Then headache, dizziness, weakness, nausea, vomiting join.

During the period of loss of consciousness, retrograde or anterograde amnesia can be observed, i.e., respectively, loss of memory for events that preceded the disorder of consciousness, or events that occurred immediately after the end of the disorder. It should be noted that all clinical manifestations intensify if the victim does not comply with bed rest.

Brain contusion

This form of closed TBI develops against the background of traumatic destruction of the brain substance. It includes all the clinical manifestations of a concussion. In addition, against this background, focal symptoms (impaired sensitivity, paresis, paralysis) are recorded, which are caused by damage (destruction) of certain parts of the brain. The victims, as a rule, are unconscious, their general condition is grave.

Compression of the brain

It occurs as a result of depressed fractures of the bones of the cranial vault or, more often, damage to the vessels of the brain with the formation of hematomas (epi- and subdural, intracerebral), which leads to the development of hypertensive syndrome.

The peculiarities of cerebral compression include the presence of a "light gap" after trauma (loss of consciousness at the time of trauma, its return for a short period of time and the rapid development of unconsciousness).

In addition, the clinical picture of cerebral compression is characterized by the following symptoms: severe, rapidly increasing in intensity headaches, hemiplegia, anisocaria, bradycardia (Fig. 6). The latter quickly turns into tachycardia. Hypertensive syndrome progresses rapidly. This is manifested in acute disorders of the functions of the cardiovascular and respiratory systems.

Figure: 6. Symptoms of brain compression:
1 - anisocaria; 2 - hemiplegia; 3 - bradycardia

Open injuries to the skull and brain

These are usually extremely serious injuries. They are divided into non-penetrating (without violating the integrity of the dura mater) and penetrating (with the violation of the integrity of the latter). The clinical picture of these injuries is very variable: from a mild degree of impairment of the general condition and neurological status to the most severe damage to vital areas of the brain with a corresponding clinical picture.

Fracture of the base of the skull

It occurs as a result of severe trauma to the skull and brain, the mechanism of occurrence of which can be direct and indirect.

The clinical picture of a fracture of the base of the skull consists of the severe general condition of the victim, up to a complete loss of consciousness, the outflow of blood-stained cerebrospinal fluid from the nasal passages, external auditory canals, along the back wall of the pharynx (an absolute clinical sign of a fracture of the base of the skull), the appearance of "bruises" (hematomas) around the eyes (on the 2nd day after the injury). In addition, when examining the state of the cranial nerves, paralysis of the olfactory, visual, oculomotor, abducens, facial nerves (all or some of them) can be detected.

Urgent treatment and tactical measures of first aid for injuries of the skull and brain

Emergency care for injuries of the skull and brain, provided by an emergency doctor, consists in the fastest delivery of the victim to the neurosurgical duty or, in the absence of such, to a surgical hospital with an intensive care and resuscitation unit, on a shield and stretcher in a horizontal position with the head turned in side or, if necessary (frequent urge to nausea and vomiting), in a stable lateral position.

Aseptic dressings are applied to the wounds. The toilet of the upper respiratory tract and monitoring of their condition are mandatory. If necessary, the introduction of an airway and oxygen therapy. In the presence of hypertensive syndrome: dehydration - 10-20 mg of lasix solution, 20-40 ml of 40% glucose solution intravenously; with bleeding intravenously 400 ml of reopolyglucin, up to 500 mg of hydrocortisone intravenously drip. To relieve pain - the introduction of non-narcotic analgesics (analgin 50% - 4 ml intravenously).

Buyanov V.M., Nesterenko Yu.A.

First aid (PMP) and the timing of its provision in traumatic brain injury plays an important role. Such damage to the brain can lead to serious consequences, among which are circulatory disorders, displacement of the gray matter, edema, and clamping of blood vessels. In addition, death from such injuries occurs in every hundredth case.

Signs

Traumatic brain injury can be mild, moderate or severe, which is determined by the time the patient is unconscious. Also, by the nature of the damage, there are closed and open types.

Establishing an open trauma is not difficult. It can be determined by external signs, such as wound and bleeding.

In the case when the victim is conscious, evidence of the presence of damage is nausea, which is accompanied by frequent bouts of vomiting, especially when changing position. It is also possible to identify closed-type craniocerebral trauma by the pallor of the facial skin, irregular heart rhythm and deterioration in general well-being.

The main manifestations include:

1. Drowsiness. The victim is constantly drowsy.
2. Dizziness accompanied by general weakness.
3. Head pain.
4. Loss consciousness. It occurs most often with moderate to severe injuries.
5. Constant nausea, periodic vomiting.
6. Amnesia. In some cases, the victim does not remember where and under what circumstances he was injured.

Prolonged unconsciousness after injury can lead to paralysis. That is why it is necessary to talk to the victim before the ambulance arrives so that he is conscious.

First aid before the ambulance arrives

Not only the duration of treatment, but also life depends on the quality and time of first aid, as well as the speed of transportation of a person to a medical institution. That is why it is important to provide help quickly and not to harm. In case of craniocerebral injuries of varying degrees and severity, it is necessary first of all to call the ambulance team.

Prior to her arrival, the algorithm for rendering the MPM will be as follows:

1. Determine if the victim is in consciousness. To do this, you need to try to bring him to his senses and monitor the reaction to pain.
2. Set type damage, the presence of bleeding. In severe injuries, leakage of cerebrospinal fluid or cerebrospinal fluid may occur.
3. Reveal availability pulse, the nature of the heartbeat. The victim, depending on the nature of the injury, may have tachycardia or bradycardia.
4. In cases where an open type damage is detected, it is necessary to apply bandage. If there is bone debris that protrudes from the wound or brain tissue is visible, a bandage is applied around the wound.
5. When the victim is unconscious, you need to establish passability respiratory tract, as a person can suffocate.
6. Delete foreign bodies that are in the nasopharynx. These can be blood clots or tooth debris.
7. In the absence of breathing, hold artificial breathing, having previously cleared the oral cavity.
8. Make it indirect massage heart with no pulse.
9. Lay down the victim on the side. This is to prevent suffocation. But if there is a suspicion of a spinal fracture, the victim is placed on his back and the cervical spine is fixed.
10. Apply to the site of injury to relieve edema cold.

In cases where the victim needs to be urgently taken by passing transport to a medical facility, it is necessary to monitor breathing, pulse and airway patency every ten minutes. If a person is conscious, you need to talk to him, asking various questions for that. This will help avoid paralysis and other consequences.

What not to do

It is possible to transport independently a victim with a traumatic brain injury only in the most urgent cases, making sure that there are no fractures of the spine and limbs.

First aid is provided only on the spot in the first minutes after injury. It must be remembered that there are a number of actions that are strictly prohibited during the provision of PMP, as this can cause serious consequences, and in some cases, death.

Forbidden:

1. Raise or carry over the victim.
2. To refuse inspection specialist, since only an experienced doctor can determine the degree and severity of the injury, as well as provide the necessary assistance.
3. Allow the victim to take sedentary position. After receiving an injury, a person may be in a state of shock and inadequately assess their condition.
4. Trying to remove protruding debris bones or other foreign bodies. This can lead to a lot of blood loss.
5. Leave the victim without supervision, as at any moment his condition may worsen.
6. To give painkillers drugs or intravenous analgesics.

Any intervention in the work of the brain, including emergency care, can negatively affect the health of the victim, the duration of treatment and the severity of clinical manifestations.

If the victim is conscious, it is extremely important to convince him to seek help from a specialist and escort him to the hospital if he is able to move independently with a mild degree of injury.

First aid for traumatic brain injury is of great importance. If it was rendered efficiently, it will help prevent the occurrence of serious consequences in the form of cerebral edema, paralysis, and circulatory disorders. But in cases where help was provided incorrectly, this becomes the cause of the development of complications or death.