home All hormones Emergency care for traumatic brain injury at the prehospital stage. Emergency first aid for traumatic brain injury: concussion, bruise, compression of the brain Nursing care for a victim with a traumatic brain injury

Emergency care for traumatic brain injury at the prehospital stage. Emergency first aid for traumatic brain injury: concussion, bruise, compression of the brain Nursing care for a victim with a traumatic brain injury

The number of accidents is steadily growing every year - such a sad price for the "benefits of civilization." Head injuries occupy one of the leading places among other peacetime injuries. Every year, an average of 700 people die, and this figure is not yet the limit. The tragedy of the situation lies in the fact that the very best leave life very early: these are children (the frequency of traumatic brain injury (TBI) is much higher in them than in adults) and young people, the so-called “color of the nation”.

Traumatic brain injury is damage to the skull and its contents of a mechanical nature, which is manifested by certain neurological symptoms. With head injuries, it is extremely important to provide first aid in time and competently so as not to lose precious time, which is why it is important for every person to know its basics.

Causes of head injuries

What causes head injuries?

traffic accidents;
falling from a height;
industrial injuries;
household injuries;
sports injuries.

Classification of traumatic brain injury

According to the nature of the damage, the following injuries are distinguished:

closed (injuries in which the aponeurosis is not damaged, but bruises and injuries of the soft tissues of the head are possible);
open (injuries in which, in addition to the skin, the aponeurosis is necessarily damaged)
penetrating (injuries in which the integrity of the dura mater is broken).

Head Injury Clinic

Brain concussion. This most common head injury occurs in 80% of cases. Macrostructural pathology is not detected, and damage is observed only at the cellular level; therefore, concussion is a functionally reversible form. The patient is unconscious for several seconds or minutes with the presence of amnesia, and is also characterized by the appearance of nausea and vomiting. After the patient regained consciousness, he complains of dizziness, diffuse headache, double vision, sweating. Vital functions are not disturbed. Minor neurological disorders manifest as asymmetry of tendon reflexes, small-scale nystagmus, which disappear after a week. The condition of patients during the first week improves significantly, and no pathology is detected during CT and MRI.

Some even tried to provide emergency care at the pre-hospital 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 extent of the injury itself, but also arise due to incorrect and untimely medical care.

With a head injury, the bones of the skull and soft tissues are damaged - the brain, its membrane, and blood vessels. Trauma has a variety of clinical symptoms, and not always its severity can be adequately assessed even by experienced traumatologists.

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

Some diseases caused by trauma have a prodromal or luminous period. After an injury, after a while the patient gets better, all symptoms disappear, the patient feels completely healthy. But this is an imaginary well-being, after a few hours or days the symptoms return and the condition of the victim deteriorates sharply. Such a clinic is typical for subdural hematoma.

In order to properly provide emergency care and at the same time not harm the patient, one should know the classification of TBI, be able to correctly and timely determine the presence of a 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:

Open craniocerebral injury (OCCT).
Closed craniocerebral injury (CBI).

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

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

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

These characteristics play a leading role in the algorithm for providing 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 those with TBI. This allows not only to increase the level of theoretical knowledge, but also to acquire practical skills in PMP.

Symptoms of TBI

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 classifies it as TBI. Diagnosis of closed TBI is much more difficult.

The main signs of a closed TBI 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, and stupor. Sometimes the victim has a memory impairment. It comes in two types:

the patient forgets the moment of the 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 tends to sleep. With severe head injuries, the patient may have a speech disorder: he answers out of place, confuses words, and his speech is sluggish. The patient himself, as a rule, is not aware of these signs. In extremely severe cases, vital functions are disrupted, which, without timely emergency care at the prehospital 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 a traumatic brain injury includes the following:

The victim must be laid on his back, preferably on a flat, hard surface, no pillows or rollers.
If the patient is unconscious, turn his head to the side - this is the prevention of aspiration of vomit at the prehospital stage. Also, this will not allow the tongue to block the supply of oxygen to the lungs.

If at the time of the injury the victim was fixed with 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.

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

Patients with TBI who are not critical to their condition require observation in a hospital.

Call the ambulance team. Describe to them the condition of the victim, perhaps the dispatcher will tell you the algorithm of actions at the pre-hospital stage.

Indications for hospitalization of the victim:

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

The main mistakes in the provision of emergency care

When providing emergency care for TBI at the prehospital stage, an inexperienced person can get confused and make several gross mistakes. It is forbidden:

seat the victim;
pull or lift the victim to his feet sharply;
leave unattended.

emergency doctor, traumatologist, neurologist, neurosurgeon

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First aid. In case of any TBI at the scene, first of all, the nature of the injury, the presence of consciousness, spontaneous breathing, and heartbeat should be determined and, in accordance with this, the necessary measures to provide assistance should be carried out.

The algorithm for providing pre-medical emergency care for TBI is as follows.

For open injury:

Apply an aseptic bandage; with bulging of the medulla, prolongation of bone fragments - with a "donut".
Release the neck of the victim from compression by the collar.
Remove from the oropharynx with a finger wrapped in gauze, foreign bodies (broken teeth, blood clots, mucus, etc.); ensure the patency of the respiratory tract (introduce an air duct, perform a triple Safar maneuver).
Perform closed heart massage (CMC) and artificial lung ventilation (ALV) (mouth to mouth, mouth to nose) if necessary. With a fracture of the base of the skull:
Make a light tamponade (without violence!) of the nasal passages, the external auditory canal.
Transfer the victim, on command, to a stretcher on his back, raise his head by 10 ° and fix it using the Cramer 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.
Carry out the simplest anti-shock measures.
Apply cold to the head.
During transportation, ensure the patency of the respiratory tract; register Ps, respiratory rate, blood pressure every 10 minutes.
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 General Surgery section

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, causing a violation of its functions.

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

Skull injuries and their characteristics

The causes of injuries of this type are the effects of a mechanical nature on the vaults of the skull. The main provocateurs of TBI are the following factors:

traffic accidents and other accidents involving transport;
Injury at work;
home damage;
A fall from a height that results in head injury.

It is important to know that the specificity of the manifestations of injury is determined by the severity of TBI, as well as its type. Sometimes the symptoms are so non-specific that it is also difficult for experienced physicians to make a diagnosis without proper diagnosis. Because of the frequent latent ("light") periods, when the patient feels relief due to the symptoms that have ceased, many people who have been injured do not want to go to the doctors. However, this is a big mistake. After 2-3 hours, the concussion again makes itself felt by a sharp deterioration in well-being.

To figure out what kind of 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:

Closed craniocerebral injury;
Open damage to the skull;
Penetrating damage.

First you need to understand what a closed craniocerebral injury is. Statistics show that closed-type injuries are the most common. They affect exclusively the integument of the skin, while maintaining the integrity of the aponeurosis. This type of injury often presents with a concussion, the hallmarks of which are unconsciousness and amnesia.

Open TBI is easy to recognize: it is accompanied by serious damage to the skin with the participation of the aponeurosis. Possible trauma to the bone and gray matter.

With a penetrating injury, the brain membrane is directly injured.

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

Consider the manifestations of each of them, highlighting the characteristic symptoms.

Shake

Considering that macrostructural pathologies are not recorded with it, concussion is a reversible process: damage affects only the cellular level. In hardware research (CT and MRI) deviations from the norm are not fixed.

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

After returning to consciousness, the patient experiences dizziness, a headache that “spills” over the entire head area, and excessive sweating. Perhaps a short-term visual impairment, manifested by double vision or flickering "flies".

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

With a brain contusion, 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 condition of the victim is characterized by the severity of these two interrelated factors. Features of their manifestation allow us to divide brain bruises into 3 groups. It can be mild, moderate or severe.

1. Light degree.

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

Vomit;
Dizziness;
Memory loss;
bradycardia;
Trembling of hands and chin;
tiptoe walking;
hypertension;
Headache, "spilled" over the entire head area;
Involuntary repetitive eye movements;
Possible manifestation of pyramidal insufficiency.

The absence of consciousness is recorded for more than 3 hours. On regaining consciousness, the patient suffers from excruciating bouts of vomiting. There are obvious mental disorders and deep memory lapses.

Symptoms are pronounced:

Significant excess of blood pressure indicators;
Weak heartbeat;
Head tilt;
Manifestations of uneven distribution of muscle tone;
Inability to move limbs;
Speech disorders.

Lack of consciousness lasts for weeks, can reach up to 1 month. The inhibition of respiratory and circulatory functions is fixed, which can lead to the death of the patient. The patient falls into a coma, which is manifested by such signs:

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

compression

Pressure on the brain occurs under the influence of hematomas, which are located above the brain. Their development is provoked by broken bones of the skull. The symptoms of compression are the same as with a brain injury. However, hematoma pressure has an important feature: the presence of a “light” period, when all signs disappear and the patient feels completely healthy.

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

Regardless of the type and degree of damage you have encountered, after providing first aid for head injuries, you should immediately contact a healthcare institution for a complete examination and appropriate treatment.

Specifics of emergency measures before hospitalization

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

In case of TBI, an immediate call to the medical team is carried out if the patient has one of the following symptoms:

Respiratory and circulatory disorders;
Incessant bleeding from the wound;
Bleeding from the ears and nose;
Being unconscious for more than 30 seconds;
Unbearable headache;
Unclear consciousness;
Loss of balance and orientation;
Frequently recurring 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 emergency care algorithm consists of quick and consistent actions:

The patient is placed on a flat hard surface.
Examine the site of damage to determine the type and nature of the injury.
Determine the stability of the heart, lungs, measuring the pulse and controlling breathing.
If a person is in a deep faint, his body is turned on its side to avoid the penetration of vomit into the esophagus and retraction of the tongue.
If the patient has an open head wound, dressing and disinfection are mandatory conditions for providing first aid for a traumatic brain injury. Before the arrival of doctors, the wound (its edges) must be treated with a disinfectant solution to prevent infections. For this, the edges of the damaged area of the 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 as to compress soft tissue.
Apply cold to the injured part of the head.
Immobilize the neck by overlaying it with rollers.
If necessary, first aid of a resuscitation nature is provided: indirect heart massage and artificial respiration.

Until the arrival of medical personnel, one should not leave the scene of the incident: at any moment a person can again fall into unconsciousness.

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

Important Information

Help for a head injury does not require special skills, but an inexperienced person may be confused, especially if there is a large blood loss when the skull is damaged. Therefore, it is important for the rescuer to stop panicking and strictly follow the instructions above. Moreover, the mistakes made can cause serious consequences of a 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, sharply changing his position;
Offer the patient medications or food;
Leave a person alone until the arrival of doctors;
Independently try to set the fragments of bones sticking out of the wound;
Remove foreign objects from the wound.

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

Treatment for traumatic brain injury is selected based on the degree and type of injury. Most often, therapy consists of actions aimed at improving cerebral circulation and preventing cerebral edema. Without fail, strict adherence to bed rest and complete rest is shown. For this purpose, sedatives are prescribed.

In severe forms of TBI, treatment consists in emergency surgical intervention, which removes accumulated hematomas.

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

Remember! Calling emergency services is free! Ambulance telephones are valid throughout the territory of 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.

Call from number 112 is possible:

If there are no funds in your account;

When the SIM card is locked

If there is no SIM card in the phone

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

Ambulance – 03*

Additional phones for calling an 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 body is washed by a special liquid that performs 2 functions:

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

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

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, skull bones).
closed. Less serious injury. The most common closed injury is a concussion.

Causes of injury

Injuries are usually the result of strong blows, sudden movements of the head, bruises. Most often, head injuries occur in major traffic accidents. Sometimes injuries occur in everyday life, while playing 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 a fall from a height, during an accident.

Damage symptoms

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

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

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

Among the external symptoms of a traumatic brain injury, there are:

scalp injury;
manifestation of convulsions;
broken bones that are visible;
neck tension;
the presence of edema, abrasions on the head;
tilting the head back;
discharge from the nose of blood, cerebrospinal fluid;
twitching of the eyeballs when looking away;
there is unequal dilation of the pupils;
the formation of bruises around the eyeballs;
when probing, the pulse is slow;
increase in body temperature;
the victim's breathing becomes noisy, intermittent.

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

Mental disorders. Among them are psychotic states, affective, volitional, intellectual-mnestic disorders, paroxysmal syndrome.
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 (bruise);
compression of the brain;
fracture of the base, cranial vault.

concussion

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

Loss of consciousness;
Loss of memory for a short period of time;
Nausea;
Dizziness;
General weakness;
Vomit;
Headache.

All symptoms usually normalize in 1 to 2 weeks.

Contusion

This type of TBI is in second place in terms of severity (if the count is 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:

Paralysis of a limb;
Disorder of hearing, vision;
Speech disorder.

Concussion symptoms are more pronounced. There is also a difference in the size of the pupils.

Brain compression

As a result of this injury, the patient develops subdural, epidural, intracerebral hematomas. This injury develops as a result of rupture of blood vessels. Blood, flowing from the injured vessel, accumulates inside the cranial cavity. Because of this, compression of certain areas of the brain is observed.

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

Oppression of consciousness;
Headache on the side of the injury;
Drowsiness;
Vomit;
Sometimes coma is possible;
One-sided dilation of the pupil is noted.

Fracture of the base, cranial vault

TBI can be accompanied by a bone fracture. Fracture of the cranial vault is of 2 types:

Linear. This species is formed by impact with a large area of contact;
Depressed. Occurs when there is a small contact area. In this case, the immersion of the bone fragment inside the cranial cavity is observed.

A symptom of a base fracture is the presence of a para-orbital hematoma. Also, the patient has an outflow 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 it increases the likelihood of infection of the cranial cavity through the nasopharynx, middle ear, and paranasal sinuses. Inside the cranial cavity, abscesses, meningitis can occur. Also, the consequences of such damage are: asymmetry of the face, impaired hearing, smell, vision.

Diagnostics

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

examination by a neurologist. Necessary for diagnosing a concussion;
x-ray examination of the skull. It is necessary to determine the fracture of bones;
echoEG. It is carried out to detect an asymmetric formation inside the skull;
ophthalmoscopy. Detects the presence of stagnant disks;
UT. Determines the presence of a hematoma, lesions;

First aid

When determining the victim of a traumatic brain injury, assistance should be provided immediately. Every minute counts. When starting to provide first aid for a traumatic brain injury, one should be aware of the possible consequences after incorrect actions. Transportation of the victim in case of TBI should be carried out by doctors. The first aid algorithm is represented by the following actions:

Make sure the victim is lying on their back. It is necessary to constantly monitor the general condition of the patient (control his pulse, breathing).
If the victim is unconscious, he must be laid exclusively on his side. This position helps to prevent suffocation, ingestion of vomit into the respiratory tract. Lying on your side eliminates the possibility that the tongue will sink and suffocation will occur.
If there is an open wound, a sterile dressing should be applied.
If the victim has an open craniocerebral injury, then when providing first aid, all edges of the wound should be covered with sterile bandages. After completing this step, you should adjust the main bandage.

First aid for traumatic brain injury is to perform the following actions. After that, you need to urgently call an ambulance for transportation to the medical center, providing further medical care to the victim. You can not do without the help of specialists in such cases:

With profuse bleeding from a wound with an open head injury.
With profuse bleeding from the nose, ears.
With no signs of breathing.
For severe headache.
In the presence of a complete loss of consciousness (if such a state lasts more than a few seconds).
If the victim has confusion.
With the manifestation of severe weakness in the upper, lower extremities. Sometimes there is immobilization of the limbs.
In violation of the usual balance.
With the manifestation of fuzziness in the speech of the victim.
In the presence of severe convulsions.
With repeated profuse vomiting.

It is also mandatory 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 an injury can manifest themselves much later.

Prohibited actions upon detection of a traumatic brain injury

Since it is impossible to transport the victim of TBI, first aid must be provided on the spot. Providing first aid to a victim with a traumatic brain injury is mandatory in the very 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 prohibited:

Treatment

The treatment of TBI is affected by the severity, the nature of the damage. 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 has entered a medical facility.

Treatment of damage in the acute period is to perform actions aimed at:

ensuring patency in the upper respiratory tract;
providing artificial ventilation of the lungs;
carrying out antishock therapy;
stabilization of hemodynamics;
maintaining blood pressure;
water balance regulation;
monitoring body temperature.

Also during this period, the need is to perform antibiotic therapy. Specialists prescribe symptomatic medical, 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 against hypoxia of the cerebral cortex;
actions aimed at preventing damage to brain tissue.

Head injuries occur due to severe damage to the skull. They can be of different types, depending on the severity of the wound. First aid for a traumatic brain injury can not only improve a person's condition, but also save his life. The most common causes of injury are:

car crashes;
a strong blow to the head on something hard (ice, stone);
falling off a bike.

How does traumatic brain injury manifest?

Traumatic brain injury can be identified by its distinctive symptoms, which usually appear gradually. As a rule, after receiving an injury, a person loses consciousness for a while.

After the patient regains consciousness, he will experience aching severe nausea and vomiting. In more severe cases, the person has difficulty speaking and walking. At the same time, his speech will be incoherent, and his face will acquire a reddish tint. With a sharp rise to his feet, he will feel dizzy, and his limbs will go numb.

If the bones of the skull or soft tissues are severely damaged, then a hematoma may form on the head or bleeding may open. Fragments of bones may also be visible. If a person's temporal lobe of the head was damaged, then he may have convulsions, partial or complete loss of memory and sensitivity (the patient will not feel pain). If first aid was not provided in a timely manner for head injuries, the patient may develop mental pathologies, strabismus, impaired hearing or vision.

First aid

Quite often, people are lost at the sight of an injured person, because they simply do not know what to do with a traumatic brain injury. The first aid method involves the following actions:

Carefully lay the injured person on a flat surface with their back down.
If a person is unconscious or fainting, then he must be slowly turned on his right side to allow the vomit to exit safely (so that the person does not suffocate while lying on his back),
Examine the wound. If it bleeds, then a clean (preferably sterile) bandage should be applied on top. If fragments of bones are visible from the wound, then it is necessary to apply a bandage around the wound, without affecting the protruding particles.
Feel the pulse and heart rate.
Check the patient's airway for blood clots, broken teeth, etc. that may interfere with normal breathing. If there are any, then carefully remove them from the oral cavity.
If a person has no pulse, then you need to do an indirect heart massage.
With a closed wound (hematoma), apply cold. It will help reduce pain and swelling.

Rules for transporting a patient with a brain injury

In order not to harm a person, after a traumatic brain injury, it is necessary to transport him only in a supine position. In this case, a person must be securely fixed with straps to the couch, otherwise, in the event of an attack of convulsions, he may fall or harm himself.

When to call an ambulance

What to do with a head injury? You need to call an ambulance at the first suspicion of, especially if it is accompanied by manifestations in the form of bleeding, convulsions, severe pain in the head, or speech disorders. The danger of such an injury is that sometimes it can only appear after a few days, so it is better to avoid complications and consult a doctor in time. After a TBI, a few days later, nausea or vomiting may appear. In this case, you need to urgently call an ambulance.

What not to do with a traumatic brain injury

It is very important for a traumatic brain injury not to harm the patient. To do this, remember that the victim must not be lifted and tried to land. He must be in a supine position.

It is also important to remember that even if a person claims to feel fine, he should not get up, because in a state of shock, the patient simply may not feel the symptoms of injury.

If foreign objects (glass, iron) or bone fragments protrude from the wound, then you do not need to remove them yourself, as this can provoke severe bleeding.

It is also important not to leave the patient without constant supervision, since at any moment his condition can change dramatically (a heart attack, loss of consciousness, a convulsive syndrome may occur). First aid for traumatic brain injury is aimed at stabilizing the general condition of a person.

Important! It is strictly forbidden to conduct independent drug therapy (giving the victim painkillers or administering painkillers), since only an experienced doctor should prescribe medications.

It is very important to use a sterile dressing during first aid for a traumatic brain injury, otherwise you can introduce an infection into the brain tissue that will provoke blood poisoning.

Every conscious person should know the basic rules for providing emergency care for a traumatic brain injury in order to be able to help the victim if necessary. After rendering assistance, the victim should be observed by a doctor. If there was, parents should carefully monitor his condition.

The brain is the "control center" of all human life support systems. Any injuries associated with blows, bruises or head areas are the cause of poor blood supply to brain cells, causing a violation of its functions.

Skull injuries and their characteristics

The causes of injuries of this type are the effects of a mechanical nature on the vaults of the skull. The main provocateurs of TBI are the following factors:

traffic accidents and other accidents involving transport;
Injury at work;
home damage;
resulting in damage to the head area.

To figure out what kind of 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:

Closed craniocerebral injury;
Open damage to the skull;
Penetrating damage.

Open TBI is easy to recognize: it is accompanied by serious damage to the skin with the participation of the aponeurosis. Possible trauma to the bone and gray matter.

With a penetrating injury, the brain membrane is directly injured.

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

Consider the manifestations of each of them, highlighting the characteristic symptoms.

Shake

Typical symptoms:

, the duration of which does not exceed 2-3 minutes or only a few seconds;
short-term memory loss;
The development of nausea, turning into vomiting.

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

Injury

1. Light degree.

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

Dizziness;
Memory loss;
bradycardia;
Trembling of hands and chin;
tiptoe walking;
hypertension;
Headache, "spilled" over the entire head area;
Involuntary repetitive eye movements;
Possible manifestation of pyramidal insufficiency.

2. Average degree.

Symptoms are pronounced:

Significant;
Weak heartbeat;
Head tilt;
Manifestations of uneven distribution of muscle tone;
Inability to move limbs;
Speech disorders.

3. Severe degree.

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

compression

Pressure on the brain occurs under the influence of hematomas, which are located above the brain. Their development is provoked by broken bones of the skull. The symptoms are the same as with a brain injury. However, hematoma pressure has an important feature: the presence of a “light” period, when all signs disappear and the patient feels completely healthy.

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

Specifics of emergency measures before hospitalization

In case of a traumatic brain injury, emergency care consists in applying the observation technique, fixing indicators that are important for maintaining a person’s life, and, if necessary. The main task of the rescuer is to maintain the functioning of important organs and systems of the patient.

In case of TBI, an immediate call to the medical team is carried out if the patient has one of the following symptoms:

Respiratory and circulatory disorders;
Incessant from wound;
Bleeding from the ears and nose;
Being unconscious for more than 30 seconds;
Unbearable headache;
Unclear consciousness;
Loss of balance and orientation;
Frequently recurring;
incessant vomiting;
Inability to move an arm or leg;
Slurred speech.

Note!

The presence of an open skull injury requires immediate hospitalization!

Very important!

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

The emergency care algorithm consists of quick and consistent actions:

The patient is placed on a flat hard surface.
Examine the site of damage to determine the type and nature of the injury.
Determine the stability of the heart, lungs, measuring the pulse and controlling breathing.
If a person is in a deep faint, his body is turned on its side to avoid the penetration of vomit into the esophagus and retraction of the tongue.
If the patient has an open head wound, dressing and disinfection are mandatory conditions for providing first aid for a traumatic brain injury. Before the arrival of doctors, the wound (its edges) must be treated with a disinfectant solution to prevent infections. For this, the edges of the damaged area of the 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 as to compress soft tissue.
Apply cold to the injured part of the head.
Immobilize the neck by overlaying it with rollers.
If necessary, first aid of a resuscitation nature is provided: indirect heart massage and artificial respiration.

Until the arrival of medical personnel, one should not leave the scene of the incident: at any moment a person can again fall into unconsciousness.

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

Important Information

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

Try to seat the patient;
Move the victim, sharply changing his position;
Offer the patient medications or food;
Leave a person alone until the arrival of doctors;
Independently try to set the fragments of bones sticking out of the wound;
Remove foreign objects from the wound.

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

In severe forms of TBI, treatment consists in emergency surgical intervention, which removes accumulated hematomas.

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

Traumatic brain injury is a collective concept that includes not only trauma to the contents of the skull (the brain, cranial nerves, blood vessels, brain ventricles, cerebrospinal fluid pathways), but also the bones of the skull. With this type of injury, not only the hemispheres of the brain, but also the so-called brain stem can suffer. This small part of the brain compared to the hemispheres regulates many vital processes, for example: breathing, control of blood vessels and the heart. They also control eye movement, smell, sight, hearing, the ability to taste, swallow, as well as metabolic processes.

Causes of traumatic brain injury:

impact impact - a direct blow to the head or to the head
anti-shock impact - a concussion is a consequence of a strong blow to another part of the body, for example: a parachutist landing on straightened legs, falling on the buttocks.

Traumatic brain injury is generally divided into three main groups:

brain concussion
brain contusion
brain compression

What are the signs (symptoms) of any traumatic brain injury?

Like any other disease, traumatic brain injury has its own symptoms. They are usually divided into two main groups depending on the area of brain damage and the severity of the impact on the brain.

cerebral symptoms - caused by a slight edema of the injured brain substance, characteristic of damage to the entire brain. These symptoms include: loss of consciousness from a few seconds to a day (depending on the severity of the injury), headache, nausea, dizziness, passing memory loss (retrograde amnesia). Perhaps a painful negative perception of noise and light, the intensity of which did not bother before the injury, general arousal, reduced criticism of one's own condition (they do not consider the injury severe, refuse hospitalization, accuse others of wanting to close them in the hospital).
focal symptoms - occur with severe damage to a specific area of \u200b\u200bthe brain. They will manifest themselves as a violation of the functions for which the affected area is responsible. For example, trauma to the temporal region of the brain can lead to hearing loss.

Brain concussion- this is the mildest form of traumatic brain injury, the main feature of which is the development of functional, reversible damage. What does it mean? This means that over time (most often a few days) all disorders in the brain will pass. Some time ago, it was customary to divide the concussion into degrees of severity, there were three of them: mild, moderate and severe. This division has now been abolished. However, in practice, after an injury, the subjective and objective well-being of the victims can largely differ. Focal symptoms in concussion are rare. Most often, we will talk about a violation of the muscles of the face, a slight visual impairment in the form of slight double vision or blurring, the victim may complain that it is difficult for him to speak, although he pronounces all sounds clearly and distinctly.

Any blow to the head, in principle, can cause a concussion. Often the decisive role is played not by the force of impact, but by the point of its application.

Symptoms of a concussion:

nausea
vomit
dizziness
headache
sleep disturbance

Emergency first aid for concussion:

strict bed rest
prevention of leakage of vomit into the respiratory tract if the victim is unconscious. This is achieved by placing the victim in a stable lateral position.
call for an ambulance
transportation of the patient, if necessary, is performed on the back with fixation of the cervical spine. How to do it right is written.

brain injury- a severe head injury, in which, against the background of a concussion of the entire brain, there is also a local more pronounced damage. Such an injury is characterized not only by cerebral symptoms, but also by focal ones. If you remember well the material read above, then you probably remembered that their manifestation depends on what function the affected area of the brain performs.

There are three degrees of brain injury:

Brain compression- an injury characterized by concussion, severe bruising and compression of the brain by severe edema or bone fragments, or intracranial hematoma. As a rule, there are several reasons for the occurrence of compression at the same time. Focal symptomatology in this case is expressed to a large extent. Consciousness in the victim may initially be present, then psychomotor agitation, an increase in headache may occur. Cardiac activity and respiration are depressed. Prolonged seizures are possible. Very often, one can observe an asymmetric change in the size of the pupils, i.e. one pupil remains of the usual size, and the second expands. This is one of the early signs of the development of an intracranial hematoma. Another of the early and very insidious symptoms is the "light gap". This is a period of complete well-being from the moment of injury to the onset of the first pathological manifestations of the nervous system. The duration of the “light gap” and the intensity of the development of symptoms of cerebral compression depend on the rate of hematoma formation. With arterial intracranial bleeding, the "light interval" can be calculated in minutes, with venous bleeding - hours. It is especially difficult to assess the severity of the condition of the victim in a state of intoxication, which can either obscure the clinical manifestations of the injury or aggravate them.

Emergency first aid for bruises and compression of the brain:

control of the patient's breathing
call for an ambulance
transportation of the patient with, if necessary, on the back with fixation of the cervical spine, prevention of leakage of vomit into the respiratory tract. This is achieved by placing the victim in a stable lateral position.
wound treatment and application of an aseptic dressing, if necessary

Each injury may well end not only in recovery, but, unfortunately, in the development of complications. With a traumatic brain injury, even with timely professional help, complications develop quite often. They can greatly affect the subsequent life of the victim. The best prevention for the development of these complications is to seek professional medical help in a timely manner!

Complications of traumatic brain injury can be:

early (traumatic meningitis, traumatic meningo-encephalitis, brain abscess, traumatic prolapse and protrusion of the brain, hemorrhage in the brain and cranial cavity)
late (traumatic arachnoiditis, traumatic arachnoencephalitis, parkinsonism, occlusive hydrocephalus, epilepsy, neuroses).

Traumatic meningitis(most often purulent) - is a severe and frequent complication of an open craniocerebral injury. Its development is caused by a diverse bacterial flora penetrating the cranial cavity during an injury. The development of this complication is also possible with poor-quality medical care.

Encephalitis- inflammation of the meninges. The occurrence of encephalitis and the severity of the course also depend on the timeliness of assistance. It develops most often with small but deep wounds. Usually, the inflammatory process begins and spreads along the wound channel, approximately 1-2 weeks after the injury. With a closed craniocerebral injury, encephalitis can develop in a crushed area of \u200b\u200bthe brain. In this case, an infection that constantly lives in other organs “sits down” on the damaged brain tissue: chronic tonsillitis, sinusitis, pharyngitis, otitis, hepatocholecystitis. It enters the injured brain with the blood stream.

brain abscess most often develops with a fracture of the base of the skull, air cavities. Of no small importance are chronic inflammatory processes in the middle ear and paranasal sinuses. If the wound does not heal, an abscess will form within about three months after the injury, sometimes sooner.

Prolapse(bulging) and protrusion(outflow) of the brain into the defect of the skull. With the progression of the infectious process in the wound, the development of encephalitis, abscess and other complications, prolapse and protrusion can increase and take a chronic course.

intracranial hematoma usually occurs with fractures and cracks in the bones of the skull.

intracerebral hemorrhage usually arise suddenly and develop as a cerebral stroke. Often, intracranial and intracerebral hemorrhages develop when the patient begins to get out of bed. Especially often this happens in older people with existing age-related changes in the walls of blood vessels. In addition, early rise of the patient from bed, leading to tension, may contribute to intracranial or intracerebral hemorrhage. This is explained by the fact that a closed cranial injury can cause a partial tear of the vessel wall, which is closed by a thrombus. With physical stress, such a blood clot can fall out and lead to intracerebral bleeding.

Traumatic arachnoiditis and arachnoencephalitis how late complications of traumatic brain injury develop as a result of traumatic necrosis and the entry of decay products into the blood. There are inflammatory phenomena of the arachnoid and vascular membranes.

In the clinical picture occlusive hydrocephalus the syndrome of increased intracranial pressure comes to the fore with the presence of a headache, at the height of which vomiting, congestive optic discs, and increased CSF pressure often occur.

Epilepsy occupies an important place among the late post-traumatic complications. Epileptic seizures can also occur in the first days after injury as a result of irritation of the cortex by foreign bodies, blood clots, or an early-developed purulent focus. Episodic seizures occur in the acute or subacute stage of a closed injury, and if these seizures do not recur later, they do not give rise to a diagnosis of traumatic epilepsy.

In some cases of traumatic brain injury, when hemorrhages occur in the subcortical nodes, it may develop parkinsonism. In the traumatic form of parkinsonism, one half of the body is often affected and a less progressive course is noted.

Late neurotic reactions observed after a closed craniocerebral injury, are manifested by mood variability, a tendency to demonstrative and installation behavior. Patients try to be the center of attention, obsessively and repeatedly talk about their experiences.

We hope that everything will be fine with you and our theoretical material will remain only a theory for you for the rest of your life! Be healthy and successful!