General principles of treatment of craniocerebral trauma
When providing first aid for patients with craniocerebral trauma, the first measures must be actions aimed at the normalization of breathing and prevention of the aspiration of vomit masses and blood that usually takes place in patients being in the unconscious state. Fortius purpose it is necessary to lay the patient on a side or turn the head aside, to control the tongue lest it should fall back. It is necessary to release the respiratory tracts from mucus, blood and vomit masses, if necessary - to perform intubation, and in respiratory compromise - to provide adequate ventilation of the lungs.
Parallelly, measures are taken on stopping the outward bleeding and maintening cardiovascular activity. The arrest of bleeding at the preadmission stage can be carried out by occlusion of the vessel, application of a compression bandage, bandaging of the vessel. Patients with severe craniocerebral trauma must be urgently delivered to a neurosurgical department.
In the absence of indications for surgical treatment of the patient (in concussion, contusion of the brain, diffuse axonal injury) they take conservative measures the nature of which is determined by the clinical form and severity of the patient's with CCT state, apparency of neurological symptomatology (intracranial hypo- or hypertension, disorders of cerebral blood flow, disorders of the liquor circulation, and others), as well as by concomitant complications, the patient's age, anamnestic and other factors.
Intensive therapy in severe CCT includes, before all, measures on the normalization of the respiratory function, the fight against edema-swelling of the brain. In cases of severe contusion of the brain with crushing and apparent edema, they use antienzymic drugs, antihypoxants and antioxidants, vasoactive preparations, gluco- corticosteroids. The intensive therapy includes also the maintenance of metabolic processes with the using of enteral (probe) and parenterally feeding, correction of disturbances of the acid-basic and water-electrolyte balance, normalization of the osmotic and colloid pressure, the system of hemostasis, microcirculation, thermoregulation, prophylaxis and treatment of inflammatory and trophic complications. With the purpose of normalization and renewal of the functional activity of the brain, they prescribe psychotropic drugs, including nootrops and GABA-ergic substances, as well as remedies normalizing the exchange of neurotransmitters.
The measures on the care of patients with craniocerebral trauma include the prophylaxis of bedsores and hypostatic pneumonia, passive gymnastics for preventing the formation of contractures in the joints of the extremities.
Surgical treatment of patients with craniocerebral trauma includes primary surgical processing in open damages, arresting of bleeding, removal of compression of the brain and liquorrhea. In all types of CCT with damage of soft tissues, one performs primary surgical processing and introduces antitenic toxoid.
Operative intervention is also employed in cases of posttraumatic complications: in suppurations of a cerebral wound, abscesses, traumatic hydrocephaly, epileptic syndrome, vast bone defects, vascular complications (carotid-cavernous anastomosis), and in some other posttraumatic changes.
Compression and dislocation of the brain are the indications for urgent operative intervention - osteoplastic or resection trepanation of the skull and ablations of the pathological voluminous process squeezing the brain.