Conservative measures in closed injuries of skull and brain

Tactics therapeutic measures is determined in each individual case manifestations of symptoms of different types of concussion, contusion, compression of the brain, injuries to the skull and soft tissue.
With mild to moderate degrees closed craniocerebral trauma in the acute period, apply the following remedial measures (some of them are extremely common, others are the methods of choice).
1. Ensuring bed rest for 10 days to 2 months. depending on the severity of the injury.
2. Symptomatic treatment headache, vomiting and insomnia.
3. Sedation (with motor or mental anxiety), which should provide only a calming effect (barbitala, barbitala-sodium phenobarbital, barbanel, bromizoval, chloral hydrate, chlorpromazine). When expressed excitement prescribed drugs barbiturova acid short-acting (Evian-sodium, geksenal pentothal), while short narcotic sleep can be extended for 6-12 hours use of sleeping pills (barbanel, phenobarbital). Sedatives, narcotic and neurologiske drugs contraindicated with suspected the possibility of formation of intracranial haematoma.
4. Dehydration therapy: hypertonic glucose, sucrose, sodium chloride and sulphate of magnesia and dioreticakih drugs, Mercosul, novoryt (to reduce intracranial and intracerebral pressure). Intravenous enter urea should only if the violation of vital functions. Dehydration treatment is not indicated for the reduction of intracranial pressure (hypotension)that is clinically diagnosed by measuring liquor pressure. Offered in these cases, intravenous distilled water or 5% glucose solution, excessive drinking and subcutaneous administration of hypotonic solutions do not take all the authors, as it is not proved that when liquor hypotension no effects edema and swelling of the brain. In addition, liquor pressure is not stable, and at different periods after injury hypotension may turn hypertension and Vice versa.
5. Treatment unloading spinal punctures shown when events liquor hypertension. Some authors are limited to a single removing 10-20 ml of liquor, others recommend handling multiple puncture with an interval of 2-3 days, referring to the best effect when combined treatment with punctures with dehydration therapy, others point to the aimlessness unloading punctures, as a therapeutic effect in terms of reducing intracranial pressure is short, and in some cases the patient's condition deteriorates. More justified treatment punctures after subarachnoid hemorrhage, in which the blood and the products of decomposition of blood and tissues have a tendency to flow into the lower parts of the spinal canal. After 2-3 times unloading lumbar puncture normal structure of the cerebrospinal fluid by increasing the production and absorption of CSF, which reduces the effects of acute aseptic meningitis and the risk of adhesive shell process in the future. Technique lumbar puncture - see Lumbar puncture.
6. Perinephral or vagosimpatical cervical novocaine blockade by A. C. Vishnevskaya is used by some authors for the normalization of hemo-, liquore - and neurodynamics. Car-sympathetic blockade designed to interrupt various pathological impulses coming from affected by brain injury causing infringements of activity of internal organs. However, the wide dissemination of these treatments has not received.
In severe traumatic brain injury special attention is drawn to the duration of loss of consciousness, respiratory failure and cardiovascular activities and development of hypoxia. The increased human vital functions, progression traumatic oedema and swelling of the brain contribute to hypoxia of the brain, growing at disorder of blood circulation and breathing; violation permanent protein and salt composition, especially pronounced in severe traumatic brain injury, shock and prolonged coma; insufficient supply of tissues energy substances; violation of the permeability of the renal parenchyma as a consequence of the inadequate supply of blood to the kidneys or very low blood pressure. Hypoxia, in particular hypoxia of the brain, leading to the development of acidosis, which in turn contributes to the strengthening of edema and swelling of the brain. Edema and swelling of the brain (see) are one of the reasons gain violation of vital functions, primarily breathing. So a vicious circle, which often can be prevented or cured timely targeted therapeutic interventions.
In the acute stage of the disease with severe traumatic brain injury improvement of metabolism of the brain and internal organs with the liquidation of the insufficient supply of oxygen and other energy substances can be achieved by the following activities: fighting human breathing through a tracheotomy (as palliative funds) and active restoration of patency of the tracheobronchial tree; an increase in the concentration of oxygen in the air we breathe; the control of acute circulatory disorders, shock elimination of symptoms and prevention of collapse, intravenous a sufficient amount of blood, plasma, macromolecular solutions and other croisements liquids, and at emergency - intra-arterial injection of blood, intravenous or subcutaneous injection of glucose or levulose. If during 2 days have been unable to obtain a satisfactory condition of the patient (patient can't eat), you must enter a sufficient amount of nutrients in the stomach and by biochemical studies to monitor dynamics of humoral balance (primarily protein, electrolyte and mediator exchanges) to assign the appropriate pathogenetic therapy aimed at normalizing humoral violations by introducing the organism holinoliticescoe, ganglioblokirtee, sympathomimetic drugs, vitamin B6, ACTH, corticosteroids, etc.
In severe cases, the application of analepticheskih substances of Central nervous system stimulants, and adrenomimeticescoe substances acting on adrenoreaktivnyh system and which is able to quickly raise your blood pressure, without the simultaneous application of the above methods normalize the function of the respiratory and circulatory usually not enough to prevent collapse.
When pronounced breathing disorders or stop its applicable subsidiary or controlled breath. If on a background vigorous measures to combat hypoxia increases hyperthermia in the absence of clinical indications pneumonia, apply pharmacological hibernation in combination with physical methods of cooling, seeking to reduce the temperature is not lower than 36 degrees. Hibernation and hypothermia used at such an alarming violations of tone, as decerebration rigidity (in cases where this is not the result of increase of compression of the brain in intracranial hematoma). We recommend simplest methods of cooling (for example, an exposure of the patient with the inclusion of the fans).
The combination of craniocerebral trauma with closed internal injuries, broken limbs, or pelvis, etc. requires urgent remedial measures (stop internal bleeding, immobilization, the fight against shock and so on), held along with the treatment of craniocerebral trauma. This damage sharply worsen the course of traumatic brain injury.