First aid to a victim with a traumatic brain injury is to give him a comfortable horizontal position with a slightly raised head.

If the person who received a head injury continues to be unconscious, the so-called rescue position is preferable - on the right side, the head is thrown back or turned to the ground, the left arm and leg are bent at a right angle in the elbow and knee joints (fractures of the limbs and spine must first be excluded) .

This position, ensuring the free passage of air into the lungs and the unimpeded outflow of fluid from the mouth, prevents respiratory failure due to retraction of the tongue, leakage of saliva, blood, and vomit into the respiratory tract.

All victims with a traumatic brain injury, even if it seems to be mild from the very beginning, are subject to transportation to the emergency hospital, where the diagnosis is specified.

The basis of treatment tactics in patients with brain injury should be based primarily on the data of an objective examination, and not the fact of a traumatic brain injury suffered by the patient.

Conservative symptomatic treatment is carried out when the patient has:

Brain concussion;

mild brain injury;

Moderate and severe brain contusion without signs of brain compression;

Diffuse axonal damage to the substance of the brain.

In the case of minor injuries that occur with a concussion picture, the treatment is purely individual.

Medical treatment for concussion should not be aggressive.

It is mainly aimed at normalizing the functional state of the brain, relieving headaches, dizziness, anxiety, insomnia and other complaints.

Conservative treatment of severe forms of traumatic brain injury (severe brain contusion, diffuse axonal brain damage) has its own characteristics and should be carried out in specialized neurosurgical hospitals, in intensive care units.

Principles of conservative treatment of mild traumatic brain injury:

Bed rest depending on the course of the disease;

Symptomatic treatment of headache;

Appointment of tranquilizers;

Normalization of CSF pressure;

Vagosympathetic blockade or blockade of the vertebral artery;

On the 5-7th day, the appointment of nootropic drugs, vitamins, vascular drugs.

The impact of a traumatic agent is a starting point for a complex of pathogenetic mechanisms, which are mainly reduced to disturbances in neurodynamic processes, disorders of tissue respiration and energy metabolism, changes in cerebral circulation in combination with a restructuring of hemodynamics, homeostatic reactions of the immune system and subsequent development of an autoimmune syndrome. The complexity and variety of pathological processes resulting from TBI, which are closely intertwined with the processes of adaptation and compensation of impaired functions, make it necessary to carry out conservative treatment of TBI in a differentiated manner, taking into account the clinical form of the lesion, age and individual characteristics of each victim.

With a concussion(SHM) pathogenesis is based on temporary functional disorders of the central nervous system, in particular its autonomic centers, which leads to the development of asthenovegetative syndrome. This determines the therapeutic tactics aimed at reducing the dysfunction of individual groups of neurons and restoring their functional synergy. When treating a concussion as the mildest form of traumatic brain injury, doctors at medical institutions often underestimate the severity of its consequences, which leads to a persistent asthenovegetative state and impaired liquorodynamics.

The complex of therapy for patients with concussion includes mandatory within 7-10 days in combination with sedative treatment, which consists in prescribing drugs that prolong physiological sleep (andante, etc. ) in the afternoon and at night. Dosing regimen The duration of therapy should not exceed 2 weeks. The drug should be taken orally immediately before going to bed, 2 hours after a meal, or after the patient feels that he cannot fall asleep. Recommended dose for adults- 10 mg. The maximum daily dose is 10 mg (the patient must be warned about the dangers of taking a repeated dose within one night). For the elderly, the drug is prescribed at a dose of 5 mg (due to greater sensitivity to sleeping pills).

A hypnotic drug of the pyrazolo-pyrimidine type, differs in chemical structure from benzodiazepines and other hypnotics. Significantly reduces the latent time of falling asleep, prolongs the time of sleep (in the first half of the night), does not cause changes in the ratio of different phases of sleep. When used at a dose of 5 mg and 10 mg for 2-4 weeks, it does not cause pharmacological tolerance. Except

In addition, it has a sedative, slightly pronounced anxiolytic, anticonvulsant and central muscle relaxant effect. It excites benzodiazepine receptors (ω) of GABA type A receptor complexes. Interaction with ω receptors leads to the opening of neuronal ionoform channels for chloride ions, the development of hyperpolarization and increased inhibition processes in the CNS.

Headache is the main clinical symptom of traumatic brain injury. A large number of medications are used to relieve headaches. The appointment of painkillers should be made taking into account the cerebrospinal fluid pressure. For example, with increased cerebrospinal fluid pressure, the appointment of citramone containing caffeine is not advisable.

In the treatment of concussion, the use of glutamic acid, picamilon (0.5 g orally 3 times a day), which is an amino acid that is oxidized directly in the brain and takes part in the regulation of oxidative metabolism. It promotes the release of mediators (adrenaline) and exhibits pronounced depolarizing properties. The drug showed itself well in the treatment of concussion mexidol. The mechanism of action of the drug is primarily determined by its antioxidant properties, the ability to stabilize cell biomembranes, activate the energy-synthesizing functions of mitochondria, modulate the work of receptor complexes and the passage of ionic currents, enhance the binding of endogenous substances, improve synaptic transmission and interconnection of brain structures.

Due to this mechanism of action, the drug has a cerebroprotective, nootropic, antihypoxic, tranquilizing, anticonvulsant, anti-alcohol, anti-stress and vegetotropic effect. In addition, it has the ability to improve cerebral circulation, inhibit platelet aggregation. Mexidol increases the body's resistance to the action of various extreme damaging factors, such as hypoxia, ischemia, and various intoxications. Mexidol has a distinct antihypoxic and anti-ischemic effect. With a concussion of the brain, it is used in a dosage: 100-250 mg (2-5 ml) intravenously or intramuscularly 2-3 times a day for 10-15 days, then 125-250 mg (1-2 tabs) 3 times a day 2-4 weeks.

The criteria for expanding the regimen should be considered the stabilization of autonomic reactions, the disappearance of headaches, dizziness (Betaver - inside, 8-16 mg 3 times a day. ) normalization of sleep and appetite.

Given the fact that CSF pressure during concussion is increased in 19-20% of cases, decreased in 25%, and normal in 55%, upon admission to the hospital, the patient must perform a lumbar puncture, which allows determining the level of intracranial pressure and choosing the right therapy. In this case, a manometric measurement of CSF pressure is mandatory with fixing its result in the medical history.

For hypertension administered orally lasix (furosemide) 40 mg 1 time per day or veroshpriron 1 tab. 1 time per day.

Under reduced pressure, intravenous administration of isotonic solutions (0.9% saline solution, 5% glucose solution) 500-600 ml 1 time per day for three to four days is necessary. The term of inpatient treatment for concussion is 1-2 weeks, followed by outpatient monitoring for 7-10 days.

In case of concussion, the complex of therapeutic measures should include the so-called reflex-drug therapy - carrying out novocaine blockades - the vagosympathetic node, the sympathetic plexus of the vertebral arteries with posterior access, etc.). This is especially important when a patient receives a craniocervical brain injury. The cause of this type of combined craniocerebral injury is the extensor-flexion mechanism in the cervical region when receiving a craniocerebral injury. This mechanism of injury in road traffic accidents is most typical.

Mild to moderate brain contusions unlike concussions, they are accompanied by morphological damage to the vessels and (or) the substance of the brain, which is manifested by focal neurological symptoms of varying intensity, subarachnoid and intracerebral hemorrhage, as well as fractures of the bones of the vault and (or) the base of the skull. Subarachnoid hemorrhage, even the smallest one, leads to vascular spasm, which, in turn, contributes to cerebral hypoxia with metabolic disorders and edema-swelling of the brain tissue. Cerebral symptoms of mild traumatic brain injury are more intense and last longer than with concussion, which determines the timing of drug therapy.

The complex of therapy for patients with cerebral contusion also includes the obligatory bed rest within 10-12 days in combination with sedative treatment, which consists in prescribing drugs that prolong physiological sleep (andante, (zaleplon) etc.). The recommended dose for adults is 10 mg. Elderly people - 5 mg. Take orally, just before bedtime, preferably in bed. Duration of treatment: no more than 2 weeks.

Upon admission to the hospital, the patient, before carrying out diagnostic manipulations, it is necessary to perform echoencephaloscopy, and after that, a lumbar puncture to determine the CSF pressure and the presence of subarachnoid hemorrhage. Lumbar punctures should be carried out before sanitation of the cerebrospinal fluid once every three to four days.

For the relief of vascular spasm, which, with a mild traumatic brain injury, causes transient neurological focal symptoms, apply stugerone (cinnarizine), papaverine, eufillin in therapeutic doses along with. The rapid elimination of vascular spasm and the removal of outflowing blood reduce the exposure of brain antigens to immunocompetent blood cells, which reduces the effect of the antigenic stimulus and reduces the intensity of the immune response. The autoimmune process either does not develop or proceeds less intensively. This is also facilitated by the appointment of antihistamines and desensitizing agents in therapeutic dosages for 1-1.5 weeks.

Recently, for the treatment of cerebral contusions of varying severity, especially those accompanied by subarachnoid hemorrhage, the drug cerebrolysin has been widely used.

Cerebrolysin contains low molecular weight biologically active neuropeptides that penetrate the blood-brain barrier and directly enter the nerve cells. The drug has an organ-specific multimodal effect on the brain, i. provides metabolic regulation, neuroprotection, functional neuromodulation and neurotrophic activity.

Cerebrolysin protects neurons from the damaging effects of lactic acidosis, prevents the formation of free radicals, increases survival and prevents neuronal death under conditions of hypoxia and ischemia, reduces the damaging neurotoxic effect of excitatory amino acids (glutamate).

In acute conditions (ischemic stroke, traumatic brain injury, complications of neurosurgical operations), it is recommended to administer cerebrolysin as drip infusions at a daily dose of 10-60 ml in 100-250 ml of saline for 60-90 minutes. The duration of the course is 10-25 days. According to research Koenig et al , 2000 The greatest effect of treatment is achieved when using Cerebrolysin 50 ml IV in 50 ml NaCl 6 hours after injury. The duration of treatment should be up to 21 days

Dehydration in traumatic brain injury is carried out depending on the magnitude of intracranial pressure and consists in the use lasix(0.5-0.75 mg/kg) parenterally or orally, glycerine(70-75 ml) inside. The criterion of effectiveness is a diuresis of 1.5-2 liters, caused by the intake of this saluretic. Glycerin at a dose of 1-1.5 g/kg reduces intracranial pressure by 50-120 mm of water. Art. for a period of 3-3.5 hours. By alternating the intake of this drug with Lasix, a uniform hypotensive effect should be achieved throughout the day. When carrying out dehydration, it must be remembered that in elderly patients in 20-30% of cases in the acute period, cerebrospinal fluid hypotension is noted. This point emphasizes the importance of lumbar puncture for determining treatment tactics.

According to the combination of pathogenetic factors, moderate brain contusion does not differ from mild brain contusion, however, persistent focal disorders, more pronounced cerebral symptoms and autonomic disorders indicate a very significant intensity of pathogenetic disorders, which strongly dictates the need for careful monitoring of the patient's condition and more active therapy. . A characteristic feature of moderate brain contusion is the instability of compensation in the acute period and the possibility of deepening disorders with untimely or inadequate therapy. With a moderate brain injury, morphological damage to the structure of the latter and massive subarachnoid hemorrhage leads to the penetration of proteolytic enzymes through the blood-brain barrier, which leads to an aggravation of neurological symptoms and the condition of patients. Therefore, already with this form of damage, the use of protease inhibitors is indicated ( contrical, gordox, trasylol), which contribute to a decrease in the permeability of the vascular wall and brain capillaries. Currently, the most widely used for this purpose contrykal 10,000 IU 3 times a day for 150 ml of 5% glucose solution for 4-6 days intravenously. With moderate brain contusion, glutamic acid is more appropriate to use in the form of a 1% solution, administered 400 ml intravenously once a day. With preserved consciousness, instead of aminalon, nootropil is prescribed in capsules of 0.4 g 3-4 times a day, and with impaired consciousness, piracetam (5 ml of a 20% solution 2 times a day intravenously).

Dehydration therapy is enhanced by the introduction of 10 ml of a 2.4% solution of aminophylline in combination with lasix (20-40 mg) intravenously up to two times a day. Such stimulation of diuresis creates a favorable gradient in the system: tissue - interstitial space - blood.

At present, approaches have also changed in the appointment of physiotherapeutic procedures for traumatic brain injury.

The difficulties of a purposeful and systematic search for the specific effects of therapeutic factors of physiotherapeutic procedures led to the exaggeration of the principles of the universality of the use of any physical factors used in physiotherapy for various diseases, the unity of the mechanisms of therapeutic and preventive action of natural and artificial physical factors that dominated in physiotherapy of the XX century. Meanwhile, doctors are well aware that physical factors in various diseases have different physiotherapeutic effectiveness. The unequal nature of diseases suggests a combination of different pathogenetic variants (syndromes).

Based on this, the reactions of the organism to the physical factor of the physiotherapeutic procedure are specific for a certain state of the organism, although therapeutic effects sometimes develop on the basis of general (non-specific) reactions of the organism.

Such specificity requires a purposeful choice of the physiotherapy factor and the method of its application, which is the essence of the pathogenetic action of therapeutic physical factors. Under these conditions, adherence to the principles of "universality" and imaginary "unity" of the mechanisms of the therapeutic effect of physiotherapy practically deprives the doctor of the possibility of the optimal choice of therapeutic physical factors. It is difficult to draw a line between the specific and non-specific action of many therapeutic factors of physiotherapy. Many of them have several effects, expressed in varying degrees, so it is better to focus on the dominant therapeutic effect.

Physical methods of treatment are aimed at improving cerebral hemodynamics (vasodilating, hypocoagulant methods), activating the metabolism of the nervous tissue and its functional properties (enzyme-stimulating methods), correcting the consequences of injuries (psychostimulating methods), increasing body tone (tonic methods) and reducing increased CSF pressure (diuretic methods).

Vasodilator methods: galvanization and medicinal electrophoresis vasodilators and stimulators of cerebral circulation. (actovegin, instenon, potassium hydroxide, eufillin, chlorpromazine, etc.)

Enzyme-stimulating methods: medicinal electrophoresis metabolism stimulants, air baths, transcerebral UHF therapy, IR laser therapy.

Diuretic methods: low intensity UHF therapy, sodium chloride baths.

Hypocoagulant method.LOC.

Psychostimulating method: oxygen baths.

Sedatives: currents of Darsonval, Faraday on the head, electrosleep, massage of the collar zone, cervical region.

Clinical picture of severe brain injury due to the involvement in the pathological process of subcortical formations and the brain stem, which is manifested by the predominance of diencephalic and mesencephalobulbar syndrome. In this regard, the volume of therapeutic measures is expanding significantly and should be directed primarily to the elimination of pathological factors that are of decisive importance in the chain of pathogenesis. At the same time, pathogenetic therapy should be carried out simultaneously with symptomatic correction of systemic hemodynamics and respiration. In the complex of therapeutic measures for cerebral contusion, the appointment of mexidol. Studies have shown that Mexidol has a cerebral vasodilation effect, reduces cerebral vascular resistance, significantly increases the pulse fluctuations of the cerebral vessels and promotes hemodynamic shifts that improve blood outflow into the venous system, without having a significant effect on systemic arterial pressure. In patients with TBI who received Mexidol, there was a significant regression of disorders of consciousness when assessed by GCS. The functions of the motor sphere were restored much faster and more distinctly, at an earlier date, there was a positive trend in the restoration of coordinating, mnestic and cognitive functions. Mexidol had a positive effect on patients with vestibular disorders, reducing uncertainty when walking, non-systemic dizziness, and oral automatism reflexes regressed faster. With a brain contusion, the therapeutic dosage is usually as follows: 200-500 mg (4-10 ml) intravenously by stream or drip 1-2 times a day for 10-15 days. Subjective and objective positive effect in the treatment with Mexidol is observed, as a rule, by the end of the week after the start of therapy.

In case of violation of peripheral breathing, the free patency of the airways is restored, the trachea is intubated with an endotracheal tube for up to 3 days. In the future, in the absence of the possibility of adequate breathing, a tracheostomy should be performed. Violation of the central regulation of respiration in most cases requires transfer to artificial ventilation of the lungs until the normal rhythm of respiratory movements is restored. Considering the development of the so-called "shock lung" syndrome in patients with STBI, particular importance should be given to measures aimed at preventing aspiration pneumonia, the development of which is very likely against the background of this syndrome. The most effective in these cases are percussion massage of the chest, vibration massage followed by aspiration of the contents of the tracheobronchial tree, soda inhalations to alkalize acidic contents that enter the lungs from the stomach and oropharynx, as well as inhalations of proteolytic enzymes, phytoncides at least 4-6 times a day. With massive aspiration with atelectasis, sanitation bronchoscopy is indicated. In specialized institutions, in the presence of an experienced anesthesiologist, a high (at the level of II-VI thoracic segments of the spinal cord) long-term epidural blockade (5 ml of 2% lidocaine solution) is advisable 4-6 hours after admission of the victim with STBI within 24-48 hours (not more!). This method is effective in the prevention of "shock lung" syndrome, but its implementation requires some experience of doctors and nurses. Treatment of systemic hemodynamic disorders should be carried out according to the principle "from simple to complex", since iatrogenic errors in the treatment of patients with severe brain contusion are fraught with serious consequences.

Elimination of hypovolemia by intravenous administration of large molecular weight dextrans (400 ml polyglucin), rheogluman and hemodez, as a rule, contributes to the stabilization of blood pressure. For the same purpose, a solution of mannitol on polyglucin has proven itself well: 30 g of mannitol and 400 ml of polyglucin (Uvarov B.S. et al., 1983). The instability of blood pressure with a full plasma volume of the bcc indicates a decrease in vascular tone, with dysfunction of the vasomotor center as a result of reversible hypoxic changes or morphological damage. This condition is stopped by the introduction of 50 mg of a 5% solution of ephedrine, as the most mildly acting vasopressor (15 mg intravenously per 10 ml of a 5% glucose solution and 35 mg intramuscularly). The absence or short-term effect of the above measures may indirectly indicate the development of acute adrenal insufficiency, and only then there is a need for the use of corticosteroids. Fundamental in this sense is the use of hydrocortisone suspension, since only it contains a fraction of mineralocorticoids, which determine the vascular effect of hormones. A more rare cause of systemic hemodynamic disorders is hypocapnia, resulting from hyperventilation, when this technique is used to stop swelling and swelling of the brain. With severe intracranial hypertension, an increase in blood pressure is compensatory in nature - it is aimed at maintaining cerebral blood flow. Therefore, measures to reduce blood pressure should be carried out with caution, since relative arterial hypotension can lead to an uncompensated decrease in cerebral blood flow, up to its termination. The use of antihypertensive drugs should be accompanied by an adequate decrease in intracranial pressure, which, in severe brain contusion, reaches critical values ​​(more than 350 mm of water column). In such cases, it is necessary to observe the principle of uniformity of dehydration therapy. In practice, this is carried out as follows: in the morning, during a lumbar puncture, 10-15 ml of liquor is slowly removed (under the mandrin) for 10-15 minutes; after 2-3 hours, 10 ml of a 2.4% solution of aminophylline with lasix (20 mg) is injected; after another 3-4 hours, an infusion of a 5-10% solution of mannitol (30-60 g) follows, after which, after 4-5 hours, intravenous administration of lasix and aminophylline is repeated, and 50-70 g of glycerol is given orally at night. If necessary, at 6-7 am, an additional 20 mg of Lasix is ​​administered intravenously. The above scheme of dehydration in most cases provides a steady decrease in intracranial pressure, which contributes to a spontaneous decrease in blood pressure to normal values. High arterial hypertension at a safe level of intracranial pressure may prevent the restoration of autoregulation of cerebral circulation. Therefore, it must be corrected by intramuscular injection of 0.5-1 ml of a 5% solution of pentamine or 4-6 ml of a 0.5% solution of dibazol. It should always be remembered that it is advisable to always precede the infusion of mannitol or other osmodiuretic with the introduction of lasix. This will avoid overloading the pulmonary circulation (pulmonary edema) as a result of transient hypervolemia and will contribute to unhindered venous outflow from the cranial cavity. Intensive diuretic therapy leads to the rapid development of potassium deficiency in the patient's body, which must be compensated by Laborie's glucose-potassium-insulin mixture. This mixture is 400 ml of 10% glucose solution with the addition of 10 units of insulin and 5% potassium chloride solution so that the patient receives at least 3-4 g of potassium per day. In the absence of renal failure and profuse diuresis, you can not be afraid of hyperkalemia. Potassium ions, penetrating into brain cells, compete with sodium ions, which reduces the hydrophilicity of tissues. Reducing the spasmodic effect of the sympathetic nervous system is achieved by blockade of the stellate ganglion or carotid sinus zone with 1% novocaine solution up to 4 times a day. Reopoliglyukin (400 ml) has a good therapeutic effect in the treatment of microcirculation disorders in the brain, the introduction of which can be repeated twice a day. In diencephalic syndrome with a tendency to hyperergic reactions (high blood pressure, tachycardia, tachypnea, persistent hyperthermia), a neurovegetative blockade is necessary, the depth and duration of which depend on the severity of diencephalic-catabolic manifestations that occur on the 2-3rd day after a severe brain injury and lasting for 4-6 days. For neurovegetative blockade, droperidol (5-10 mg), seduxen (10 mg), diphenhydramine (40 mg) and pyrroxane (10-20 mg) are preferable, which are administered simultaneously intramuscularly or (less often) intravenously. It is advisable to alternate the introduction of this lytic mixture with the use of sodium thiopental (300 mg of a 10% solution intramuscularly up to 3 times a day). Without interfering with the spread of excitation along the axons of neurons, they reduce the excitability of the cerebral cortex, reduce the brain's need for oxygen and at the same time increase the excretion of CO 2 .. Like other barbiturates, these drugs reduce lactate levels and restore the metabolism of buffer bases in the brain. In case of insufficiency of drug-induced neurovegetative blockade and resistance to hyperthermia, physical cooling is resorted to (drying wet tissues on the patient with a fan, wrapping with ice packs) until the body temperature drops to a normal or subnormal level (36.5-37.5 C). Before the start of physical cooling, it is advisable for the patient to intravenously inject 20 ml of a 20% solution of sodium oxybutyrate, 5 mg of droperidol and 50-100 mg of a 5% solution of nicotinamide. The use of prostaglandin inhibitors (acetylsalicylic acid, less often indomethacin), which improves microcirculation in the brain and normalizes thermoregulation, has also been shown. In case of hyperthermia of infectious genesis, broad-spectrum antibiotics should be used, the route of administration of which (intramuscularly, intravenously, endolumbally, intracarotidally) depends on the type and severity of the inflammatory complication. Indications for surgical treatment in severe brain contusion occur with intracranial hematomas, foci of brain crush, pneumocephalus, depressed skull fractures, edema and dislocation of the brain caused by the growth of an unremoved contusion focus. Hyperbaric oxygenation is an effective method of treatment and prevention of hypoxic conditions in case of severe brain contusion with foci of crushing of the cerebral hemispheres. It is most effective in patients with lesions of the diencephalic and mesencephalic parts of the brain stem of secondary origin. The optimal mode is a pressure of 1.5-1.8 atm for 25-60 minutes (with mesencephalic lesions 1.1-1.5 atm for 25-40 minutes). Contraindications to hyperbaric oxygenation in case of severe brain contusion are: unremoved intracranial hematoma, unresolved upper respiratory tract obstruction, bilateral pneumonia, severe epileptic syndrome, primary brainstem suffering at the bulbar level and other individual contraindications established by a specialist (Kasumov R.D. et al., 1982). The period of inpatient treatment depends on the intensity of the recovery processes, the activity of rehabilitation measures and averages 1.5-2 months.

If a child hits his head, first of all, it is necessary to exclude the possibility of a traumatic brain injury (TBI). The mildest degree of TBI is considered to be a concussion.

In principle, the brain is well protected: it is surrounded on all sides by liquid (liquor) and placed in the cranium. But upon impact, intracranial pressure changes due to small liquorodynamic disturbances, although the brain itself is not damaged. Nevertheless, it is a rather serious problem that requires medical examination and treatment.

Doctors often make such a diagnosis for children, especially babies from 0 to 3 years old. Of course, not every fall or bruise results in injury. But if we consider the mechanism of the fall, it turns out that the children fall on the back of the head at high speed. The kid does not have time (cannot) group and falls on his back, then hits his head with great acceleration. The degree of injury depends on the height from which the crumb fell, and on how the blow went: directly or tangentially.

Symptoms of a possible concussion in a child

If you find a hematoma under the skin, be sure to consult a doctor.

Concussion is indicated by: vomiting or urge to vomit, loss of consciousness (even for a second), weakness and headaches. It should be taken into account that a short-term loss of consciousness often goes unnoticed, and the baby may not be told, especially if he still does not know how to talk. So, in case of hitting the child's head and the presence of a soft tissue injury (especially if a bruise has appeared in the frontal, temporal region), it is necessary to contact a medical professional. Do not let the child drink or eat before the doctor arrives, so as not to provoke vomiting.

It is impossible to delay the examination of a doctor and leave blows to the head unattended - too. Headaches can appear even two weeks after the injury. It often happens like this: they didn’t pay attention to the bump, and then they bring the child to the doctor with headaches. Then it turns out that he hit his head a couple of weeks ago. There is nothing good here, because the acute period has already passed. And during this period of time, the baby had to observe bed rest.

Concussion treatment

During a concussion, a child needs rest. The acute period lasts up to three weeks.

If a child has a suspected concussion, they should be examined by a neurosurgeon. If the diagnosis is confirmed, he will prescribe medications that normalize cerebrospinal fluid and hemodynamic disorders (associated with impaired blood and cerebrospinal fluid movement), strengthen the walls of cerebral vessels.

By the way, the baby will most likely not be put in the hospital. Children recover faster at home. However, for a week and a half, the activity of the crumbs should be reduced.

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According to statistical studies, concussion is one of the leading diagnoses for head injuries in both older people and children. Doctors believe that the most dangerous thing in this situation is not the damage itself, but the consequences that appear after it. Therefore, it is recommended to be responsible for your health and in case of deterioration of health, immediately contact a specialist.

To help a person before the arrival of doctors, you must do the following:

1. Lay the injured person on a horizontal surface with a hard base.
2. Turn the face as close to the ground as possible to avoid the retraction of the tongue or the entry of vomit or other bodily fluids into the respiratory system.
3. Having excluded fractures of the spine and lower extremities, it is required to lay the victim on his side, bending his right leg 90 degrees and putting his hand under his head.
4. If an open head injury is detected, it must be treated with an antiseptic, and the edges should be additionally lubricated with iodine.

It must be remembered that you can help a victim with a suspected concussion, not being a medical worker, only in order to alleviate his condition. It is forbidden to give the patient any medication until the ambulance arrives. Only after a thorough diagnosis, a neuropathologist can prescribe the correct course of treatment.

Medical indications

Before choosing a method of therapy, it is important to analyze the causes of a concussion. This may happen due to:

• domestic injury;
• accident.

Particularly severe consequences of such damage are often manifested in the elderly in the form of:

Because the brain is made entirely of soft tissue, a sudden change in head position or impact can have a negative impact on its structure. In this case, there is a risk of hematoma formation due to rupture of blood vessels, which leads to a deterioration in cerebral blood supply.

This condition is characterized by the following symptoms:

• cephalgia;
• dizziness;
• nausea;
• impaired coordination of movements;
• deterioration of vision.

If, after an accident or domestic injury, a person has the above symptoms, it is urgent to contact a neurologist or traumatologist. To make an accurate diagnosis, the doctor without fail prescribes research, including:

• computed tomography;
• radiography;
• magnetic resonance imaging;
• electroencephalography.

Medical treatment

The main thing in the treatment of concussion is the absence of aggressive drugs. As a rule, treatment is aimed at normalizing the functioning of the main organ of the central nervous system, relieving headaches, improving sleep, getting rid of dizziness, anxiety and other possible pathological conditions.

Most often, analgesics, hypnotics and sedatives are prescribed in the form of tablets, less often - intramuscular injections.

Often, analgesic medications are selected by the doctor on an individual basis. Nevertheless, you can get rid of discomfort in the head area yourself with the help of:

• "Analgin";
• "Sedalgina";
• "Pentalgina";
• "Baralgin";
• "Maxigan".

The following medications may be prescribed to relieve dizziness:

• "Tanakan";
• "Betaserk";
• "Bellaspon";
• "Microzer";
• "Belloid";
• "Platifillin";
• "Papaverine".

Among the sedatives note:

If anxiety develops into constant anxiety, tranquilizers may be prescribed by a doctor:

• "Phenazepam";
• "Sibazon";
• "Nozepam";
• "Rudotel";
• Elenium.

Additional Measures for Recovering from an Injury

A speedy recovery is facilitated by taking multivitamin preparations and tonics, such as Eleutherococcus or ginseng root.

It is also important to take additional therapeutic measures aimed at normalizing vascular and metabolic disorders. This helps to speed up the process of recovery of brain activity and prevent the possible development of postconcussion syndrome.

Effective drugs are neurometabolic stimulants (Aminalon, Picamilon, Encephabol, Nootropil) and vasotropes (Stugeron, Cavinton, Sermion, Theonicol). But also doctors often prescribe the drug "Gliatilin". In various treatment options, "Cavinton" can be prescribed, 1 tab. (5 mg) three times a day and Nootropil 2 capsules (0.7 mg) once a day or one tablet of Stugeron (25 mg) and Encephabol (0.1 mg). The duration of the course of treatment is 1-2 months.

To eliminate asthenic syndrome, the following medications can be prescribed: Cogitum 20 mg once a day, Pantogam 0.5 mg three times a day, Vasobral 2 ml twice a day and one of the multivitamin drugs, such as Unicap-T, Centrum and Vitrum, once a day.

When receiving a traumatic brain injury, the elderly must definitely supplement the treatment with anti-sclerotic drugs. In addition, it is important to pay due attention to the prevention of other diseases that may develop as a result of a concussion.

If the patient is experiencing epileptic seizures, it may be necessary to take anticonvulsants.

To prevent possible dangerous consequences, it is required to visit a doctor periodically within a year after the treatment.

Rehabilitation

To enhance the effect of drugs and exclude possible complications in the post-traumatic period, the patient must follow the following recommendations:

If the prescribed therapy is ignored and the post-traumatic regimen is not followed, the risk of such dangerous consequences as asthenia, emotional-behavioral and cognitive impairments, and vegetative-vascular dystonia increases. People who abuse alcohol can develop epilepsy.

According to the degree and nature of brain damage at the time of injury, there are: concussion with the presence of only cerebral symptoms; contusion (bruise) of the brain with the presence of cerebral and focal symptoms; severe traumatic brain injury, accompanied by prolonged loss of consciousness with life-threatening symptoms of damage to the trunk and subcortical formations, often combined with compression of the brain by intracranial hematomas.

Concussion. With a mild degree of concussion, a short-term loss of consciousness (several seconds or minutes), headache, nausea, and vomiting are observed. A moderate concussion is accompanied by a short-term or relatively long-term loss of consciousness (up to several tens of minutes), after which nausea, vomiting, headache, dizziness, spontaneous nystagmus, retrograde amnesia, cardiovascular disorders, vegetative disorders are observed.

For injury (concussion) the brain is characterized by the same symptoms as with a concussion, but with more pronounced and persistent focal symptoms. In accordance with the location of the lesions in the brain, sensory disturbances, paresis, more persistent and severe mental disorders are observed. Brain contusion is usually combined with intracranial hemorrhages. In the late period, residual effects of focal brain damage, the development of epileptic seizures are often observed.

At severe traumatic brain injury there is a long-term impairment of consciousness, reaching the degree of coma, in combination with severe respiratory disorders, cardiovascular activity, metabolic processes and thermoregulation. Fractures of the base of the skull due to the simultaneous violation of the integrity of the membranes and rupture of blood vessels usually occur with bleeding from the ears and nose, hemorrhages in the conjunctiva and bruising around the orbit.

The source of hemorrhages that occur during brain contusions are either the arteries of the pia mater (subarachnoid hemorrhages) and the brain itself, or the venous sinuses (subdural hemorrhages) and the vessels of the dura mater (epidural hemorrhages). With hemorrhages, hematomas are formed, causing compression of the brain. Epidural and subdural hematomas are characterized by an increase in cerebral and focal symptoms after a "light" period after injury. With a rapidly growing hematoma, there may not be a “light” gap. An important diagnostic sign is a wide pupil on the side of the hematoma, as well as the development of local convulsive seizures and paresis on the side opposite to the localization of the hematoma.

Treatment. Patients with brain injuries must be urgently hospitalized. In mild forms of concussion, bed rest and complete rest for 5-7 days are indicated. If there is a headache, dizziness, asthenic syndrome, tranquilizers, analgesics, and in some cases diuretics are prescribed. During the first 5 days, even with a mild concussion, it is necessary to constantly monitor the patient's condition so as not to miss the first symptoms of a developing hematoma. In more severe forms of concussion and bruising in the acute period, rest, bed rest, cold on the head are prescribed, and when excited, tranquilizers are prescribed. To combat cerebral edema, diuretics are used: lasix (furosemide). A good effect is obtained when glycerol is administered orally in apple or other acidic juice in a ratio of 1:3 (1 dose of glycerol and 3 doses of juice) - take 1 tablespoon 4-5 times a day for 7-10 days. To reduce intracranial pressure under strict medical supervision, you can use glucocorticoids - hydrocortisone, dexamethasone. Prescribe drugs that regulate cardiovascular activity. If epi- and subdural hemorrhage is suspected, special studies (echoencephalography, angiography, etc.) and surgical treatment are carried out.

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Brain concussion

(brain injury closed)

Accompanied by loss of consciousness, usually short-term, vomiting or nausea immediately after the injury, headache and dizziness. The headache is dull, sometimes there is only heaviness in the head and a feeling of dizziness inside the head. When examining such a patient, one can note the pallor of the face, soreness and lacrimation when asked to take the eyeballs to the sides. Unpleasant sensations, accompanied by nausea, occur in patients when asked to look at fast-moving, flashing objects or at the finger of the subject, which brings it closer to the patient's nose.

6. Treatment. Bed rest for 2-3 days followed by home rest for another week (5-7 days), after which general rest can be allowed. During the first 5 days, active monitoring of the patient is necessary (for the dynamics of headache, pulse rate, state of consciousness, so as not to miss the first symptoms of brain compression due to a developed hematoma - see Brain Compression).

Intravenous administration of 40% glucose solution 20 ml (5-7 infusions) or intramuscular injections of 25% magnesium sulfate solution 5 ml each (also 5-7 infusions every other day) are recommended. Inside designate tazepam, Rudotel or Luminal 1/2 tablet 2-3 times a day. Sometimes a good calming effect is given by valerian extract in tablets. With persistent headache, the number of infusions or injections can be increased (up to 15). Injections are replaced by ingestion of glycerin, which is diluted with sour juice in a ratio of 1: 3 (one dose of glycerin and 3 doses of juice); take 1 tablespoon 4-5 times a day for 7-10 days.

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