Help with traumatic brain injury

Assistance in traumatic brain injury is to take the following measures:

• Intubation of the trachea through the mouth under direct visual control, with linear immobilization of the cervical spine by hand (BCC is often combined with damage to the cervical spine).
• Intravenously induction with a drug that prevents an increase in intracranial pressure due to laryngoscopy. The choice of the drug is not important, the main thing is to choose a dose that avoids fluctuations in blood pressure (do not use ketamine, as it raises blood pressure, cerebral blood flow and ICP). Propofol is widely used.
• Rapid sequential induction with the use of suxamethonium (1 mg / kg) - remember the possibility of a full stomach and sharp expansion of it.
• Introduce an orogastric probe for decompression of the stomach.
• Mechanical ventilation supporting RaO2> 13.5 kPa (100 mm Hg) and RazO24,5-5,0 kPa (34-38 mm Hg).
• Maintain sedation and neuromuscular blockade with short-acting drugs (such as propofol, fentanyl, atrakurium) for ventilation and to prevent coughing.
• Liquid therapy 0.9% saline or colloid, supporting SBP> 90 mm Hg. Art. - if ICP is monitored, the goal for MTD is> 60 mm Hg. Art. The choice of the volume of liquid is more important than its composition, but glucose-containing and hypotonic solutions should be avoided.
• To maintain blood pressure at an adequate level, in particular to mitigate the hypotensive effect of sedatives, inotropes may also be required.
• Mannitol 20% (0.5 g / kg) can be used in the complex treatment of elevated blood pressure - it is useful to consult specialists of the neurosurgical center.
• Urgent CT in patients with a high risk of intracranial hematoma or with SCG <8 after resuscitation.

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Indications for referral to a neurosurgeon

CT signs of fresh intracranial hemorrhage / hematoma. The patient corresponds to the indications for CT, but it can not be performed on site. The clinical picture of the patient causes concern, despite the CT scan.

What neurosurgeon will want to know when addressing him?

Age of the patient and his history (if any). Anamnesis and the nature of the damage. Neurological status. Did the patient speak after the injury? ShKG at the scene and on arrival at the reception. Dynamics of the ShKG from the moment of receipt. Reactions of pupils and extremities. Cardiorespiratory status: blood pressure and heart rate, blood gases, chest X-ray. Damage: fractures of the skull, extracranial lesions. CT and X-ray: exclude pneumothorax, other studies dictated by the situation.

Doing: intubated and for mechanical ventilation? Support of blood circulation? Treatment of concomitant damage, monitoring, medication and injected fluids - dose and time of administration.

Further medical care in case of traumatic brain injury

• Conduct a detailed re-examination to identify other lesions.
• First of all, it is necessary to treat active bleeding and other life-threatening lesions of the chest and abdominal cavity, while not forgetting about increased intracranial pressure and not stopping its targeted treatment.
• Treat convulsions with anticonvulsants - phenytoin 15 mg / kg.
• Discuss with neurosurgeons the indications for CT in patients with CCT

Indications for emergency CT

• ShKG 12 points or lower after resuscitation (for example, it opens the eyes only to pain or does not respond to reversed speech).
• Deterioration of the level of consciousness (a decrease in SDG by 2 points or more) or the progression of focal neurological symptoms.

Indications for urgent CT

• Confusion or drowsiness (SSC 13 or 14) without improvement within the last 4 hours.
• X-ray or clinical signs of a skull fracture, regardless of the level of consciousness.
• The appearance of new neurologic symptoms, without deterioration.
• ShKG 15 without fractures of the skull, but with one of the following:
  • severe, persistent headache;
  • nausea and vomiting;
  • irritability or altered behavior; once cramps.

When providing first aid in cases of craniocerebral trauma, it is necessary to clearly differentiate this damage with the following conditions:

• Alcohol or drug intoxication.
• Subarachnoid hemorrhage or other spontaneous intracranial hemorrhage.
• Anoxic / hypoxic intracranial lesion.

Transportation in case of assistance in case of head injury

• Before the start of transportation, adequate stabilization and assistance should be achieved in cases of head injury.
• During transport all necessary equipment for resuscitation and monitoring, medicines, intravenous access, devices for infusion should be available.
• Medical personnel carrying out transportation should have adequate training and experience in resuscitation and intensive care, and be sufficient in number.
• Good contact and understanding between the sending and receiving institutions is necessary before and during transportation.
• Records, protocols of research and procedures, X-rays and scans should be with the patient.