ICD ZCHMT concussion head. Closed cranopy and brain injury (concussion brain, brain injury, intracranial hematomas, etc.)

04.03.2020

This class uses for coding different species injury Certain letters. S are often used to encoding damage to a certain part of the body, but the letter T is to encode numerous injuries of individual non-refined parts of the body. Also this letter is made to encrypt poisoning and some other consequences of the impact of external factors.

Each component of damage should be encoded separately.

Codes MKB-10 S00-S09 - Head injuries

In this SCB blocking unit, experts include the following damage:

It is worth noting that medical workers do not contribute damage from damage, burns, insect bites. Damage is also excluded in a consequence of foreign bodies in a throat, ear, nose, mouth and larynx.

S06 intracranial damage to zhmt

Damage to the skull may be caused by a variety of reasons. Most often, intracranial injury is accompanied by the injury of the central nervous system structures or other serious pathology.

Brain injury. This damage is most often characterized by a focal macrostructural impairment of the substance in the brain with a different degree of severity. Diagnosis is carried out only in cases where the symptoms complement other signs of lesion of the body. Allocate several degrees of the bruise at once:
- Easy. At the same time, a person loses consciousness for a few minutes, and also experiences nausea, dizziness and vomit urge. All vital functions are not violated. It is possible in the future fractures of bones of skull and hemorrhage.
- Average. A person loses consciousness a few dozen minutes or even hours. Appears headache And repeated vomit urge. Frequent manifestation mental violations, Including excitement, reduce the ability to speak normally and think. Thermal pressure is significantly increased, shortness of breath appears. There are often cases of partial amnesia in a person with a medium degree of brain injury.
- Heavy. The patient can lose consciousness for several hours or even days. Respiratory disorder appears and vascular motor system. Symptoms focal weakly pronounced, but slowly progressive. Hemorrhage appears in the brain, as well as bone fractures.
Brain-brain. Damage to the mechanical energy of the skull and brain. This concept includes not only a picture developing in the starting hours after damage, but also physiological, clinical manifestations inherent in healing.

Codes on the ICD-10 concussions of the brain, intracranial injuries and other SCMT:

S06.0 Brain concussion. Functional brain damage, which is quite reversible. Man gets a short-term loss of consciousness. In subsequent levels of development of the disease, more pronounced changes appear.
S06.1 Traumatic edema. Because of which small bumps and abrasions appear on the head. This may indicate the presence of hemorrhage in the brain. Symptomatics is quite pronounced and accompanied by vomiting, headache. There is a feeling of drowsiness and fatigue.
S06.2 Diffuse Brain DiffusionThe most common type of crank-brain injury, the reason for which the road accident often acts.
Diffuse damage almost always begins with a rather long coma. You can immediately assume the development of such a violation, especially if stem functions are affected.
S06.3 Hearth injuryThe brain injury with the focal lesion of certain brain tissues. Such a violation is characterized by the presence of the main focus of the ignition of the nerve tissues.
S06.4 Epidural hemorrhageMentrely solid shell of skulls and bones can form clutch blood. This is what is the consequence of violations leading to all sorts of consequences. Hemorrhage into the human brain most often begins as a result of accidents or strong shocks on the head.
S06.5 Traumatic subdural hemorrhage. The test type of hematoma is often associated with cranopy symptoms. In this case, the blood is thickened between the solid and the sputum shells of the brain, due to the break of the veins. The person increases intracranial pressure and the brain substance is damaged.
S06.6 Traumatic subarachnoid hemorrhage. In this variety of hematoma, blood thickening takes place between the web and soft shells. Owning due to the rupture of the artery or after the cranial injury.
S06.7 intracranial violation with long comatous state . Decisions as a result of injury or strong impact can go into a comatose state. In this case, the intracranial hematoma is developing, which provokes long-term to whom. Doctors initially eliminate damage itself, after which they bring a person to a normal state.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Post-traumatic encephalopathy - what it is and how to treat

Post-traumatic encephalopathy is the consequences of CHMT, manifested in the form of changes in the functions and structures of the brain of varying severity. Mental, vestibular, mental and vegetative disorders can manifest itself within 12 months from the date of injury and thereby significantly limit everyday life. With severe forms of brain damage, the patient is recognized as disabled, since his life-supporting functions are limited.

The disease is a complication of CMT, therefore, according to the ICD-10, it is most often assigned to the code T90.5 - "The consequences of intracranial injury" or G93.8 - "Other clarified brain diseases". If post-traumatic encephalopathy is accompanied by edema of tissues and pronounced hydrocephalus, it can be attributed to the G91 - "Hydrocephalus acquired" code.

Degree of post-traumatic encephalopathy

According to the severity, post-traumatic encephalopathy is classified according to the following features:

1 degree - not recognized by visual symptoms and features, since the nature of the damage to the tissues of the brain is insignificant. Identify violations caused by injury or concussion, using diagnostic or laboratory research, as well as by the method of special samples.
2 degree - characterized by manifestation of neurological signs in the form restless sleep, fast fatigue, emotional instability, reduction in concentration and memory. Symptoms are manifested in a slightly and episodically.
3 degree - due to a strong traumatic impact on the patient's tissue in the patient, serious disorders occur in the CNS, which can manifest itself in the form of such complications as dementia, epileptic seizures, Parkinson's disease.

Conclusion about the severity of post-traumatic encephalopathy makes a neurologist on the basis of the nature of damage to the brain structures and the manifesting symptoms.

Causes of the disease

Post-traumatic encephalopathy is a complication of transferred cranial injuries of the II or III degree, which can be obtained in the following cases:

in the process of childbirth in babies;
accidents - automotive, wreck on the plane;
blow on the head or drop on her heavy item;
fights, beatings obtained, including, and as a result of sports contests;
fall, hit head about land or other solid surface.

After traumatic impact in the structures of the brain, changes occur, which may cause the development of post-traumatic encephalopathy:

immediately after injury in the tissues of the brain, edema is formed, which makes it difficult for blood flow by vessels;
due to the deficiency of oxygen, the affected section of the brain begins to atrophy, decreasing in the sizes;
the space formed as a result of the drying of the space of space is filled with liquid liquid, which presses on nearby fabrics and irritates nervous endings;
the pressure of the lycvore significantly disrupts blood supply, as a result of which the brain cells begin to split and die.

Spaces in brain structures, which can also be filled with liquid, often occur after the resorption of intracranial hematomas obtained as a result of injury. In these spaces, porencephalic cysts can be formed, which also squeeze the tissues of the brain and thereby contribute to their dying.

Symptoms and signs of post-traumatic encephalopathy

The symptoms of post-traumatic encephalopathy manifests itself and increases within 1-2 weeks, while the nature and severity of neurological disorders will depend on the size of the focus and the brain lesion site.

The development of post-traumatic encephalopathy is indicated by the following signs:

Memory disorders. Short-term amnesia may be present directly after the injury suffered or at the time when the victim woke up after the loss of consciousness. Austion should state when a person begins to forget the events that occurred after a traumatic case.
Reduced concentration. The patient becomes scattered, inhibited, inattentive, slow, quickly gets tired both from mental and physical work.
Violation of mental functions. A person cannot think logically and analytically, in such a state he commits thoughtless acts, it is not able to take adequate decisions in everyday life and professional activities.
Reducing coordination. Patient post-traumatic encephalopathy is difficult to keep equilibrium and coordinate their movements. He manifests the scalance of gait during walking, sometimes it is difficult for him to get into the doorway.
Violations of speech, manifested in the form of a slow and unbearable conversation.
Change behavior. A person begins to manifest behavioral qualities and character traits that do not have previously peculiar to him (for example, apathy for what is happening, outbreaks of irritability and aggression).
Lack of appetite.
Insomnia.
Headaches that are difficult to remove with painful drugs.
Racing arterial pressureaccompanied by sweating and weakness.
Nausea arising suddenly.
Dizziness, often emerging after physical labor.

In the delayed period, over the course of the injury, epilepsy attacks may appear in patient post-traumatic encephalopathy, indicating the deeper damage to the structures of the brain.

Diagnosis and treatment of post-traumatic encephalopathy

To diagnose post-traumatic encephalopathy, neurologist first of all knows the patient information about the injury, namely:

statute of limitations;
localization;
severity;
manifested symptoms;
treatment method.

After that, the doctor prescribes additional examination by instrumental methods:

MRI and CT - to identify the degree of traumatic impact and signs of brain atrophy;
electricencephalography - to study the frequency of basic rhythms and determining the degree of epileptic activity.

After examination, the patient is prescribed medicia treatmentaimed at eliminating negative effects of injury and recovery brain Functions. An individually physician is selected for drugs of the following groups:

diuretics - with diagnosed hydrocephalic syndrome;
analgesics - with head pains;
nootropic tools - for recovery exchange processes between brain cells;
neuroprotectors - to restore and nutrition of nerve cells;
vitamins "B" - to power the brain and improving its activities;
anticonvulsants - with confirmed by experts, epilepsy attacks.

Auxiliary therapy plays a major role in restoring brain functions during post-traumatic encephalopathy:

physiotics;
physiotherapy;
acupuncture;
massage - classic, manual, point;
help psychologist.

Depending on the degree of damage to the brain and the intensity of the manifestation of symptoms, the patient is assigned treatment with courses, the time interval between which is 6 months or a year. During the rest of the time, he should comply with several basic requirements:

eat properly;
make daily walks - on foot and over fresh air;
abandon detrimental habits;
regularly visit the neurologist to control the state of health.

Forecast and consequences

With a confirmed post-traumatic encephalopathy, a long-term rehabilitation will be patient to restore disturbed or lost brain functions.

During the year, a person passes therapeutic and recovery courses, as well as social adaptation activities in cases where violations of the brain activity entail a restriction in personal care and discomfort in everyday life. Only after this period, the doctor can make a forecast for the degree of restoration of the brain functions.

If, after the past rehabilitation, it is not possible to restore lost functions and disability, then disability is prescribed to patient post-traumatic encephalopathy. Depending on the form of pathology, it is assigned one of the following groups:

II or III Group - with a diagnosed 2nd degree of gravity of pathology, while the patient can work under the condition of light labor and abbreviated labor day.
І Group - with the disease of the 3rd degree due to the reduction or complete absence of the possibility of care for himself and need for assistance.

Disability is not prescribed to patients with post-traumatic encephalopathy 1st degree, since the impact of symptoms characteristic of this state does not reduce their quality of life and performance.

Choosing a doctor or clinic

Possible consequences after the cranial injury and the illegality code on the ICD-10

1 causes and classification of the disease

The consequences of CMT on ICD-10 have code T90.5. The brain injury is fixed in the case when damaged soft fabrics Skulls, as well as brain. Most often, the reason becomes:

strike a head;
road traffic accidents;
sport injuries.

All brain injuries are divided into 2 groups:

If injured occurred and it turned out that the integrity in the field of soft tissues of the head was broken, then this is a group of open injuries. If the bones of the skull were damaged, but the solid brain shell remained the whole, it means that injuries are counted to the discharge of impenetrable. Penetrating them are called if the bones were damaged and solid shell also. The closed form is characterized by the fact that soft tissues are not affected, without aponeurosis, broken the bones of the skull.

If we take into account the Pathophysiology of CMT, then there are damage:

Primary. At the same time, the vessels, the bones of the skull, the brain fabric, and the shell, are also affected by the likvarny system.
Secondary. Do not have a direct connection with brain damage. Their development occurs as a secondary ischemic change in brain fabrics.

There are injuries corrective complicationsThe most common among them:

Be sure to take into account the degree of gravity:

Easy. Consciousness is clear, no pain, health does not threaten much.
Average. Consciousness is clear, but it is also possible that a person feels a little frightened. Pronounced focal signs.
Heavy. Sopor arises, strong stun. Vital actions are broken, there are focal signs.
Especially hard. The patient falls into someone, non-dust or deep. Vital functions are violated strongly, as well as the cardiovascular and respiratory system. There is a focal symptom. Consciousness is absent from the pair of hours to many days. The movements of the eyeballs are bliss, and the reaction of pupils on bright stimuli is oppressed.

2 Diagnostic methods and periods of disease

Patients with cranopy and brain injuries must be examined. Based on the determination of the degree of oppression of consciousness, the extent to which neurological symptoms are expressed, whether other organs are damaged, the diagnosis is made. It is more convenient for these purposes to use the scale of Glasgow's coma. Check the condition of the patient immediately after injury, after 12 hours and a day.

The patient is asked to produce certain movements, answer questions and open and close the eyes. At the same time, they monitor the reaction with external irritating factors.

In medicine, several periods of the disease are distinguished:

If a shaking occurred, then most often the patient is experiencing a sharp headache. It is possible to loss of consciousness, vomiting arises, the head is spinning.

A man is weak, becomes sluggish. But there is no stagnation in the eye day, the brain is locally not amazed, the cerebrospinal fluid has the same pressure.

If the brain injury occurred, then the person pursues his headache at the point of impact, constant vomiting, difficulty breathing and bradycardia appears, pallor and elevated temperature. During the examination, it is detected:

at spinal fluid - the presence of blood;
in the blood - an increased number of leukocytes.

Maybe violation and speech. At this time, it is necessary to be under the supervision of the doctor, as a traumatic epilepsy may occur, accompanied by attacks of convulsion. And this process often causes depressive states and aggressive behavior, fast fatigue.

Intracranial hematomas, skull fractures can cause brain compression. This is due to various kinds of hemorrhages obtained due to injuries. Often because of hemorrhage that occurred between the bones of the skull and the brain shell, it is at the point of impact, an epidural hematoma occurs. It can be determined by an aisocoria with expansion. Often the loss of consciousness. At the same time, the diagnosis is most often required surgery.

With a subdural hematoma, strong head spasms, vomiting arise, begins to be gathering in subdural space. Blood. A convulsions arise. Patients cannot navigate in space, quickly tired, but at the same time are too excited and irritable.

To confirm the diagnosis caused by injury in the skull area, you will need additional research:

X-ray skull when there is a suspicion of his fracture.
EMG will help determine what the degree of lesion in muscle fibers and myonevel endings.
Neurosonography. With it, it is determined by intracranial hypertension, hydrocephalus.
UDG to check whether the pathology did not occur in the brain vessels.
Blood chemistry.
MRI to define lesions in the brain.
EEG to identify dysfunction of stem structures of the brain.

Diagnostics will determine the consequences of the skull injury.

The consequences of the CMT code on the ICD 10

1046 universities, 2204 items.

Closed cranial trauma (concussion of the brain, injury

Purpose of the stage: Restoring the functions of all vital systems and organs

S06.0 Brain concussion

S06.1 Traumatic brain swelling

S06.2 Diffuse brain injury

S06.3 Heat brain focal injury

S06.4 Epidural hemorrhage

S06.5 Traumatic subdural hemorrhage

S06.6 Traumatic subarachnoid hemorrhage

S06.7 intracranial injury with a long comatose

S06.8 Other intracranial injuries

S06.9 intracranial injury uncomputed

Definition: Closed Card and Brain Injury (ZCHMT) - Damage to the skull and

brain, which is not accompanied by a violation of the integrity of soft tissues of the head and / or

uponework stretching skull.

The open CMT includes damages that are accompanied by a violation

the integrity of the soft tissues of the head and the aponeurotic helmet of the skull and / or corresponding

wash the fracture zone. The penetrating damage includes such a CMT that has

widges the fractures of the bones of the skull and damage to the solid brain sheath with

the occurrence of liquor fistulas (lycvorea).

Primary - damage due to direct exposure to injuries

powered skull bones, brain shells and brain tissue, brain vessels and liquor

Secondary - damage not related to direct brain damage,

but due to the consequences of primary brain damage and develop mainly

by the type of secondary ischemic changes Brain fabric. (intracranial and systems-

1. intracranial - cerebrovascular changes, violations of liquorocyer

liances, brain swelling, changes in intracranial pressure, dislocation syndrome.

2. Systemic - arterial hypotension, hypoxia, hyper- and hypermings, hyper- and

hyponatremia, hyperthermia, impaired carbohydrate exchange, DVS syndrome.

In the severity of the patients with CMT - is based on the evaluation of the degree of coal

the consciousness of the victim, the presence and severity neurological symptoms, on the-

licacy or absence damage to other organs. The greatest distribution of

chila Glasgow Coma (proposed by G. Teasdale and B. Jennet 1974). Status

giving evaluated at the first contact with the patient, after 12 and 24 hours in three parameters

ram: opening the eye, speech response and motor reaction in response to the external

dragoncy. Allocate the classification of disorders of consciousness at CMT, based on

evaluating the degree of oppression of consciousness, where the following gradations exist

The Light ZChMT includes the concussion of the brain and the brain bruise easy

degree. ZCHMT middle degree gravity - brain injury middle severity. To

zhelya ZCHMT belongs to the injury of the brain of severe and all types of headings

2. Middle severity;

4. Extremely severe;

Satisfactory condition criteria are:

1. Clear consciousness;

2. No violations of vital functions;

3. Lack of secondary (dislocation) neurological symptoms, absence

ordinary severity of primary semi-coarse and crani-bean symptoms.

There is no threat to life, the displacement of disability is usually good

The criteria of the state of moderate gravity are:

1. Clear consciousness or moderate stunning;

2. Vital functions are not violated (only bradycardia is possible);

3. focal symptoms - those or other half-and-old and crane can be expressed

basal symptoms. Sometimes single, gently expressed stem

symptoms (spontaneous Nistagm et al.)

To establish the state of moderate severity is enough to have one of

specified parameters. The threat to life is insignificant, the forecast of the restoration of labor

abilities are more likely favorable.

1. Changes in consciousness to deep stunning or spin;

2. Violation of the vital functions (moderate one by one - two indicators);

3. Focal symptoms - stem are moderately expressed (anisocorium, light limitation

rejecting a look up, spontaneous nystagm, contralateral pyramidal failure

the dissociation of meningeal symptoms along the body axis, etc.); can be sharply

wives of half and cranified symptoms, including epileptic seizures,

pares and paralysis.

To establish a difficult state, it is permissible to have these disorders.

would one of the parameters. The threat to life is significant, largely depends on

severe states, disgraceability of ability to restore disability

1. Violation of consciousness to moderate or deep coma;

2. A sharply pronounced violation of the vital functions in several parameters;

3. Focal symptoms - stem are expressed clearly (parires of the gaze up, expressed

anisocorium, eye divergence vertical or horizontal, tonic spontaneous

nistagm, weakening the reaction of pupils into light, bilateral pathological reflexes,

decerebraction rigidity, etc.); Half and cranified symptoms sharply

expressed (up to bilateral and multiple paresis).

When establishing an extremely severe state, it is necessary to have pronounced

in all respects, and one of them is necessarily the limit, threat for

maximum life. Forecast displacement is more often unfavorable.

Terminal state criteria:

1. Violation of consciousness to the level of the coma;

2. critical violation vital functions;

3. Focal symptoms - stem in the form of limit bilateral mydriasis,

the essence of corneal and pupil reactions; Half and craniobasic usually re-

covered with general-selling and stem violations. The forecast of the survival of the patient

2. Open: a) impenetrable; b) penetrating;

By type of brain damage differences:

1. brain concussion- a state that arises more often due to

little traumatic strength. It is found almost 70% of victims of the CHMT.

A concussion is characterized by the lack of loss of consciousness or short-term loss

consciousness after injury: from 1-2 dominant. Patients complain of headaches, Tosh

note, less often vomiting, dizziness, weakness, pain when moving eyeballs.

There may be a light asymmetry of tendon reflexes. Retrograde amnesia (EU-

whether it occurs) short-term. Anterorograd amnesia does not happen. With concussion

the mentioned phenomena of the brain are caused by the functional lesion of the brain and

after 5-8 days pass. To establish a diagnosis, optionally

all specified symptoms. Concussion of the brain is a unified form and not

divided into severity;

2. brain injury- this is damage in the form of macro structural destruction

brain substances, more often with a hemorrhagic component that occurred at the time of the application

traumatic power. By clinical flow and severity of brain damage

brain bums are divided into bruises of light, medium and severe):

Burn brain easy(10-15% of victims). After injury,

rata of consciousness from a few minutes to 40 minutes. Most have retrograde amne

zia for the period up to 30 minutes. If an anterorographic amnesia arises, then she is not

resident After the recovery of consciousness, the victim complains of headache,

nausea, vomiting (often repeated), dizziness, weakening attention, memory. Maybe

to be detected by Nistagm (more often horizontal), anisaneflexia, sometimes light hemiparesis.

Sometimes there are pathological reflexes. Due to subarachnoid hemorrhage

lyans can be detected easily expressed meningeal syndrome. Can observe

sia Brady and Tachycardia, transient increase in blood pressure Namm RT.

art. Symptoms regress usually within 1-3 weeks after injury. Injury

a lightweight brain can be accompanied by fractures of the bones of the skull.

Middle Degree Brain Break. The loss of consciousness lasts from

how many dozen minutes to 2-4 hours. Oppression of consciousness to moderate or

deep stun can persist for several hours or days. Observed

a pronounced headache, often re-vomiting. Horizontal nistagm, weakening

the reaction of the reaction of pupils into light is possible to disrupt the convergence. There is a discs

the cyanization of tendon reflexes, sometimes moderately pronounced hemiparesis and pathological

sky reflexes. There may be impairment of sensitivity, speech disorders. Menin

geal syndrome is moderately expressed, and the liquor pressure is moderately increased (

the key to the victims, which have Likvorea). There is tachy or bradycardia.

Respiratory disorders in the form of a moderate tachipne without a rhythm disturbance and does not require appa-

ratish correction. Subfebrile temperature. In the 1st day can be psychomotor

excitation, sometimes convulsive seizures. There is a retro and anteroraterograde amne

Heavy degree brain injury. The loss of consciousness lasts from several hours to

how many days (in part of patients with the transition to appeallic syndrome or akinetic

mutism). Infertility of consciousness to a spin or coma. May be a pronounced psychomotor

an excitation imposing atonia. Stem symptoms are expressed - floating

movement of eyeballs, difference of eyeballs on the vertical axis, fixation

looking down, anisocorium. The reaction of pupils for light and corneal reflexes are depressed. Swallow

nope is violated. Sometimes the city of pain irritation or spontaneously develops.

Bilateral pathological stop reflexes. There are changes in muscle tone

ca, often hemiparez, anisuflexia. There may be convulsive seizures. Violation

breath - on a central or peripheral type (tachy or bradypnee). Arteri

or improved, or reduced (may be normal), and with atonyc

the coma is unstable and requires constant medication support. Expressed

To the special form of brain bruises diffuse axonial damage

brain. His clinical signs Include a function violation brain stem - Ugne-

consciousness to a deep coma, a sharply pronounced violation of the vital functions, which

these require mandatory drug and hardware correction. Mortality

diffuse axonal damage to the brain is very high and reaches 80-90%, and

supported appealic syndrome. Diffused axonal damage can

accompanied by the formation of intracranial hematomas.

3. Brain compression ( growing and unlatenizing) - happens by reducing

intracranial space with volume formations. It should be borne

that any "harsh" compression at the CMT can become increasing and lead to

severe compression and dislocation of the brain. To unraoper compresses include

sorrowing bones of skull with indulged fractures, pressure on the brain

mi foreign bodies. In these cases, the comprehensive brain itself is not increased

it is in volume. In the genesis of the brain compression, secondary intracrapers play a leading role

mechanisms. The growing compresses include all types of intracranial hematomas

and brain bruises accompanied by mass effect.

5. Multiple subordinate hematomas;

6. Subdural hydromes;

Hematoma can be: sharp (first 3 days) subacle (4 days-3 weeks) and

chronic (Later 3 weeks).

Classical __________ Clinical picture of intracranial hematomas includes availability

light gap, anisocoria, hemiparesis, bradycardia, which meets less often.

The classic clinic is characteristic of a hematoma without a concomitant bruise of the brain. At

suffering from hematomas in combination with brain injury from the first hours

CMT there are signs of primary brain damage and symptoms of compression and dislief

brain kation caused by brain tissue injury.

1. Alcoholic intoxication (70%).

2. CMT as a result of an epileptic attack.

1. Road injury;

2. Household injury;

3. Fall and sports injury;

Pay attention to the presence of visible damage to the scalp.

Periorubital hematoma ("Symptom of Points", "Eyes of Raccot") indicates a fracture

the bottom of the front worm. Hematoma in the area of \u200b\u200bthe deputyid process (symptom of butt

la) accompanies the pyramid of the temporal bone. Hhemoxpanum or breaking the drum

noque membrane can correspond to a fracture of the base of the skull. Nose or ear

likvorea testifies to the fracture of the base of the skull and penetrating CHMT. Sound "Tres

dwelled pot "at percussion of the skull may occur during the fractures of the bones of the Code

turnip. Exophthalm with swelling conjunctiva may indicate the formation of carotid

cavernous coolest or on the resulting retrobulbar hematoma. Hematoma soft

kih fabrics in the occipuric cervical region can accompany the fibrous bone

and (or) the bruises of the poles and the basal departments of the frontal fractions and the poles of temporal fraction.

Undoubtedly, the assessment of the level of consciousness, the presence of meningeal

symptoms, the status of pupils and their reaction to the light, the functions of the cranial nerves and

functions, neurological symptoms, an increase in intracranial pressure,

brain dislocation, development of acute likvorn occlusion.

Tactic provision medical care:

The choice of tactics of treatment of victims determine the nature of the damage

the brain, the bones of the arch and base of the skull, concomitant extra charge injury and

vitia complications due to injury.

The main task in providing first aid to victims of the CHMT is not

to start the development of arterial hypotension, hypoventilation, hypoxia, hypercapnia, so

how these complications lead to severe ischemic brain lesions and accompanied

high mortality.

In this regard, in the first minutes and hours after injury, all therapeutic activities

must be subordinated to the Rule "ABC":

A (AIRWAY) - ensuring the passability of the respiratory tract;

In (Breathing) - Restoration of adequate respiration: Elimination of the obstruction of breathing

waters, drainage pleural cavity with pneumatic-, hemotorax, IVL (by

C (circulation) - control over the activities of cardio-vascular system: Fast

restoration of the BCC (transfusion of crystalloid solutions and colloids), if not

myocardial accuracy is the introduction of inotropic drugs (dopamine, dobutamine) or vase

pressors (adrenaline, noraderenlin, Meston). It must be remembered that without normal

circulating blood mass The introduction of vasopressors is dangerous.

The testimony for the intubation of the trachea and the holding of the IVL are apnea and hypoapnoe,

the presence of cyanosis of the skin and mucous membranes. Intubation through the nose has a number of advantages

tC At CMT, the likelihood of a shaven-spinal injury is not excluded (and therefore

all victims of injury to refine the nature of the injury at the pre-hospital stage

dimo fix the cervical spine, overlapping special cervical gates

nicknames). To normalize the arteriovenous oxygen difference in the victims of the CHMT

it is advisable to use oxygen-air mixtures with an oxygen content to

The obligatory component of the treatment of severe CMT is the elimination of hypovole

myi, and for this purpose, liquid is usually introduced in the amount of 30-35ml / kg per day. Except

are patients with acute occlusal syndrome, in which the pace of CSZH products

directly depends on water balance, so they are justified by dehydration, allowing

having reduced pschd.

For the prevention of intracranial hypertension and her damaging brain

the consequences at the pre-hospital stage are used glucocorticoid hormones and salure

Glucocorticoid hormones warn the development of intracranial hypertension

ziya due to stabilization of the permeability of the hematostephalic barrier and reduction

fluid transduction into brain tissue.

They contribute to the decline in peripocal edema in the area of \u200b\u200binjury.

At the pre-hospital stage, it is advisable intravenous or intramuscular introduction

prednisolone in a dose of 30 mg

However, it should be borne in mind that due to the concomitant mineralocorticoid

the prednisone effect is able to delay in the sodium body and strengthen elimination

potassium, which adversely affects general condition patients with chmt.

Therefore, it is preferable to use dexamethasone at a dose of 4-8 mg which

practically does not have mineralocorticoid properties.

In the absence of circulatory disorders simultaneously with glucocorticoid

hormones for brain dehydration is possible to assign high-speed salureti-

cOV, For example, the lazix in the dosage (2-4 ml of 1% solution).

Gangli-blocking drugs at a high degree of intracranial hypertension

contraindicated, since with a decrease in systemic blood pressure can develop

the complete blockade of cerebral blood flow due to the compression of the brain capillaries of the edema

To reduce intracranial pressure - both in the pre-hospital stage and in

hospital - do not use osmotically active substances (mannitol), for

with a damaged hematorecephalic barrier, create a gradient of their concentration of

waiting for the substance of the brain and the vascular channel fails and probably deterioration

patient due to the rapid secondary increase in intracranial pressure.

Exception - the threat of brain dislocation accompanied by severe

breath disorders and blood circulation.

In this case, it is advisable to intravenous administration of mannitol (mannitol) from the calculation

that 0.5 g / kg body weight in the form of a 20% solution.

The sequence of urgent assistance measures on the chipboard

When concussing a brain urgent care not required.

With psychomotor excitation:

2-4 ml of 0.5% Sedukesen solution (relaignation, sybazone) intravenously;

Transportation to the hospital (in the neurological department).

When bruised and squeezing the brain:

1. Ensure access to Vienna.

2. When developing the terminal state, make a heart resuscitation.

3. When decompensating blood circulation:

Reopolyglyukin, crystalloid solutions intravenously drip;

If necessary - dopamine 200 mg in 400 ml of isotonic sodium solution

chloride or any other crystalloid solution intravenously at speeds

walking the maintenance of blood pressure at the RT levels. st.;

4. With an unconscious state:

Inspection and mechanical cleaning of the oral cavity;

Application of selllick reception;

Implementation of direct laryngoscopy;

Spine in the cervical department does not bind!

Stabilization of the cervical spine (easy pulling hands);

Intubation of the trachea (without minelaxants!), Regardless of whether

can be found or not; Miorosanta (Succinylcholine Chloride - Dicillin, Leafenon in

dose 1-2 mg / kg; Injections are carried out only by the doctors of resuscitation and surgical

With ineffectiveness of independent respiration, artificial fans are shown

lungs in moderate hyperventilation mode (12-14 l / min for a patient with a body weight

5. In psychomotor excitation, cramps and as premedication:

0.5-1.0 ml of 0.1% of the atropine solution subcutaneously;

Intravenously propofol 1-2 mg / kg, or sodium thiopental 3-5 mg / kg, or 2-4 ml 0.5%

sedukene solution, or Milm 20% sodium solution of oxybutirate, or Dormicum 0.1-

During transportation, the respiratory rhythm is needed.

6. With intracranial hypertensive syndrome:

2-4 ml of 1% furosemide solution (lazix) intravenous (with decomposed

blood loss due to the combined injury of Laziks not to enter!);

Artificial hyperventilation of the lungs.

7. With pain syndrome: intramuscularly (or intravenously slow) 30mg-1.0

ketorolac and 2 ml of 1-2% solution of diphrol and (or) 2-4 ml (mg) 0.5% solution

tram or other nonarcotic analgesic in the respective doses.

8. When wounds of the head and outdoor bleeding of them:

Wire toilet with edges treatment with antiseptic (see ch. 15).

9. Transportation to the hospital where there is an neurosurgical service; when crying

in the intensive care unit.

List of basic medicines:

1. * Dopamine 4% 5 ml; amp

2. Dobutamine solution for infusion 5 mg / ml

4. * Prednisolone 25mg 1ml, AMP

5. * Diazepam 10 mg / 2 ml; amp

7. * Sodium oxybat 20% 5 ml, AMP

8. * Magnesium sulfate 25% 5.0, AMP

9. * Mannitol 15% 200 ml, FL

10. * Furosemid 1% 2.0, AMP

11. Meston 1% - 1.0; amp

List of additional medicines:

1. * Atropine sulfate 0.1% - 1.0, AMP

2. * Betamethasone 1ml, AMP

3. * Epinephrine 0.18% - 1 ml; amp

4. * Destrane, 0; FL

5. * Diphenhydramine 1% - 1.0, AMP

6. * Ketorolak 30mg - 1.0; amp

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CIFRES OF CIRCITIONS - brain injury Code on ICD 10 is a list of injuries, which describes the main cases associated with the fact of damage to the tissues of varying severity, a number of complications, consequences.

ICB 10 brain injury - a class of intracranial injuries under the code S - an open or closed cranic and brain injury with damage to the internal structures. It is the defeat of the shells of a substance accompanied by focal necrosis of nerve tissues.

The injury can occur in any area of \u200b\u200bthe head, but most often suffer from frontal, temporal, occipital shares.

When lesion, a zone with high pressure occurs. This section is destroyed both the bloodwered network and nervous structures. As a result, a shockproof area with reduced pressure with relevant damage arises in the opposite part. Pressure change provokes the formation of a set of hemalopese point character. Suffering and intact departments. The swelling and swelling is caused, the blood supply to the tissues is disturbed.

Surface brain shares during injury are shifted, and the depths are not moving, which leads to a change in the transfer of nerve pulses. For the same reason, there is a violation of the circulation of the spinal fluid.

Symptoms and signs

The diagnosis of the ICR brain injury gives a wide idea of \u200b\u200bthe painting of the sides. Variation of signs and manifestations depends on the nature, degree of damage.
The most common:

Loss of consciousness;
Pronounced pain in the head;
Dizziness;
Drowsiness;
Emotional, mental changes;
Subtaching, urge to vomiting;
Amnesia of different duration;
Slowness of reactions;
Shift of blood pressure indicators;
Breathing, heartbeat;
Increasing body temperature;
Reaction disorder from the nervous system;
Edema, hemorrhage, destruction of brain fabrics.

Possible:

Fractures of the face of the head, arches and bones of the skull;
Damage to the skin;
The hematomas of subdural type, bruises.

Severity

The International Classifier of Diseases (ICD-10) divides the cranknogo for three types:

Easy - is particularly common among adults and children. It is characterized as ZCHMT, the injury of a haystone cover with minor changes in reflex indicators. There is a clarity of consciousness, the norm in respiratory and motor activity;
Average - has a greater severity of symptoms, is accompanied by brain violations, leading changes in the consciousness, heart functioning, CNS, vitality not change;
Heavy - the most serious view with bright neurological deficiency in the brain activity leading to the greatest consequences. Consciousness is absent more than six hours, the reactions of pupils are strongly reduced. Inappropriate assistance to the victim leads to disability, death.

Diagnostics

Studies are carried out in several stages:

Analyzing the neurological state, classification based on history, complaints, external inspection;
Blood on biochemical indicators;
Estimation of the state of the brain structures with: X-ray (the presence of fractures, cracks), neurosonography (change in intracranial pressure), UDG (on the pathology of the vascular network), EEG (on the functionality of the stem system), EMG (activity of neuromuscular synapse), MRI (foci lesions of fabrics).

Treatment

Therapy of the painful state of soft brain structures depends on the degree of damage. Lightweight and medium injuries are subjected to a conservative technique:

Full peace, if necessary, hospitalization;
Diet;
Analgesics, antispasmodics, anticonvulsant;
Preparations for normalization of blood supply, metabolism;
Therapy of edema of cerebral structures;
Resuscitation.

In severe cases, trepanation is carried out.

Effects

The result of the injury brain as a child and in an adult is a post-traumatic encephalopathy. Accompanied by:

Reduced care, memory, mental abilities;
Pain in the head;
Sleep violation;
Unstable emotional state.

With serious injuries, blood circulation is changed, the cerebrospinal fluid, causing signs of hydrocephalius.

The brain injury or contusion is CMT, as a result of which the structure of the brainstant is disturbed. Moreover, all these violations are irreversible, damaged cells and structures are not regenerated.

There is a destruction of the brain substance, as a rule, in two foci: the place of impact on the head and the place of the opposite, where the brain is injured about the bone of the cranial box. Moreover, the second focus is often more than the first.

The brain injury can occur as a result of household or production injury, an accident or criminal encroachment, hitting the head or hit head about a solid surface. Most often, such an injury happens as a result of an accident.

According to the international classification of diseases (ICD-10), this injury is assigned the S06 code and it is indicated in this document as intracranial injury. In accordance with this classification, the brain injury, as opposed to concussion, can be both closed and open, i.e. With a fracture of the bones of the skull.

Severity

In Russian medicine, the brain injury, depending on the size of the focus of brain tissue, is three degrees of gravity:

1. Easy.

2. Average.

3. Heavy.

Each degree is characterized by its symptoms, clinic and forecast. This classification is sufficiently conditional, because In practical medicine, neurologists, traumatologists, neurosurgeons are sometimes difficult to carry out clear distinctions.

Easy brain injury.

Any brain injury entails, above all, the loss of consciousness. The victim is unconscious from a few minutes to an hour. After he comes to himself, he does not remember a small segment of time before injury and the moment of its causes. In addition, it complains of:

In the victim, a pronounced neurology has a victim with a light brain injury:

nistagm;
easy squint;
a weak reaction of pupils into light;
reduced reflexes, etc.

With timely and proper treatment within a few weeks, all the symptoms take place without a trace, and the injury in the end does not harm the health of a person.

Medium brain injury.

Upon receipt of such injury, the victim loses consciousness for the period from tens of minutes to several hours. Having come to themselves, he does not remember a sufficiently large segment of time before getting a injury and the moment of its cause. In addition, he has the following symptoms:

strong headache;
severe vomiting;
rapid or slow heartbeat;
increased blood pressure;
increased body temperature;
partares, paralysis, etc.

Most often, the middle brain injury is accompanied by the fractures of the bones of the skull, as a result of which the CMT becomes open. And it is especially dangerous to such an injury in the brain.

Timely and proper treatment retains the life to the patient, but the probability of subsequent disability is very large.

Heavy brain injury.

Upon receipt of this injury, the affected head loses consciousness for a period of several hours to several weeks, and in the future it can go to the state of the coma. Come to consciousness, he does not remember the period of his life up to several weeks preceding the injury, and the moment of its cause. In addition, he has the following symptoms:

violation of respiratory and blood supply functions;
inability to talk;
inability to understand the speech of others;
epileptic seizures, etc.

With this injury, the bones of the skull and hemorrhage in the brain are almost always there.

According to medical statistics, half of the head victims of the head does not survive, and the rest become disabled for the rest of his life. Even after months and years of treatment and rehabilitation, the victim remains many mental, neurological and motor disorders.

Diagnostics

The brain injury is diagnosed by a common and neurological inspection, as well as using instrumental methods:

radiography;
computed tomography (CT);
magnetic resonance tomography (MRI);
electroencephalography (EEG);
neurosonography (ultrasound for small children) and so on.

Most often, lumbar puncture is made for the detection of red blood cells in the Likvore.

Treatment

Treatment of brain injury is carried out only in stationary conditions.

Depending on the circumstances, treatment can begin in resuscitation (as a rule, in the case of severe bruise). Next, it can be continued in neurosurgery, if the tight trepanation is required.

And the conservative treatment of this injury (as a rule, with light and middle injury) occurs in the trauma and neurological department.

Initially, all the efforts of doctors are aimed at maintaining the functions of respiration and blood circulation, as well as other vital functions. In parallel, the therapy of brain edema is carried out. Medicinal preparations are prescribed on symptoms (anticonant, analgesics), as well as drugs that improve intracranial blood circulation, brain activity, if necessary, antibiotics and so on.

While the patient is unconscious, he receives parenteral nutrition, after surgery, a diet No. 0 (postoperative) is prescribed, and with conservative treatment - a special medicinal diet.

Ask a question specialist

Card-brain injury (CMT) - damage to the mechanical energy of the skull and intracranial content (brain, brain shells, vessels,). The concept of CMT includes not only a clinical picture developing in the first hours and days after injury, but also a complex of physiological and clinical manifestations inherent in the recovery period (sometimes lasting).

Code for the international classification of diseases of the ICD-10:

S06 -

Frequency

In Russia, the brain damage occurs every year more than 1,000,000 people. The leading cause of death in men younger than 35 years old. Most often occurs at road traffic accidents (in 50% of cases), during falls, fights, sports (with an increased risk of injury to the head).

Classification

According to the nature of the CHT. Closed and open. Criterion - the presence / absence of wounds with a violation of the integrity of a tendon aponeurosis (although from a clinical point of view, this separation has little meaning). Impervious and penetrating. The criterion of penetrating chmt is the damage to the brain shells, the expiration of the liquor. For the prevalence of damage. The focal (brain injury, intracerebral hematomas). Diffuse (brain concussion, diffuse axonal damage). According to the presence of concomitant injuries. Isolated - damage only head (as a result of mechanical exposure). Combined - CMT in combination with traumatic damage to other parts of the body (facial skeleton, internal organs, limbs). Combined - CMT (defeat as a result of the effects of the mechanical factor) in combination with burns, radiation damage, etc. By clinical form. Brain concussion. The injury brain is focal (easy, moderately, heavy degree). Diffuse axonal damage. According to the severity (the main criterion is the degree of oppression of consciousness, see the scale of the coma of Glasgow in the hemorrhage of subarachnoidal). Easy degree - concussion brain, brain injury easy degree. Average degree - the injury of the brain of moderate severity. The heavy degree is a heavy degree brain injury.

Clinical signs . Loss of consciousness. Signs of injury of soft head tissues. The total-selling symptoms arises with an elevated PCD - with a brain edema, additional volumes in the skull cavity (for example, hematoma), see the head of the brain. Focal neurological symptoms (depending on localization). Signs of growing and dislocation syndrome: inhibition of consciousness, progression of symptoms of the lesion of the hemispheres of the brain, the appearance of clinical signs of the brain stem dysfunction. Post-traumatic amnesia (duration depends on the severity of damage).

Trauma Card-brain: Diagnostics

Diagnostic tactics

Consistent assessment of vital functions, level of consciousness on the Glasgow scale, the assessment of focal neurological disorders. CT is recommended to perform all patients in an unconscious state for more than 2 hours, as well as to all patients with focal neurological symptoms. The cervical spine - 5% of patients with severe CMT observe the accompanying fracture of the cervical vertebrae. Overview Craniography is shown in suspected of an indulged by a fracture or on the fracture of the base of the skull, which failed to visualize with CT. As a screening method in patients with a high probability of intracranial pathology, it is not used. MRT does not have any diagnostic advantages compared to CT, so it cannot be considered a standard diagnostic method.

Differential diagnosis - Comatous states. Transportation: in the position of lying on the rigid surface, it is necessary with the immobilization of the cervical spine. With a combined and combined CMT, treatment is necessary for the treatment of related urgent states.

Operational treatment

Operational treatment (primary surgical processing of the wound) is shown in all cases of open CMT. Indications for operational intervention with intracranial pathology - see the hematoma intraceragovaya traumatic, subdural hematoma, epidural hematoma.

Conservative therapy

Intensive therapy, aimed at maintaining vital functions. Monitoring and correction of elevated PBF (see hematoma intracranial traumatic). Anticonvulsants - during cramps. The preventive purpose of anticonvulsant drugs is justified only in the first week from the moment of CHMT.

Complications

Potted - inflammatory (meningitis, encephalitis, brain abscess, subdural empya, osteomyelitis bones of the skull). Preventive purpose Antibiotics does not affect the risk of developing these complications. Neurovegetative (changes in peripheral and central hemodynamics, thermoregulation). Psychopathological.

Four and forecast

The more easier the severity of CMT, the better the forecast. Forecast TMT depends on age. Adults: Positive dynamics are best expressed during the first 6 months after CMT, after 2 years there is no further improvement in the state. Children: Forecast for functional recovery is more favorable. In children, the intracranial hematoma is less common, more characteristic of adults. Elderly: a tendency to deterioration of the disease forecast with an increase in the patient's age. We often develop subdural hematomas with an estate clinical picture. Mortality for heavy TMT reaches 50%. If consciousness begins to clarify for 1 week after a heavy TMT, the forecast is more favorable. Signs of primary damage to the brain barrel (coma, irregular respiration, the lack of reaction to light, loss of ochelocephalotic and oculosetting reflexes, diffuse muscle hypotension) almost always imply a heavy degree of CMT and a bad forecast

Exodes Currently, in neurosurgical practice, the "Glasgow Exodes" is used to evaluate the results of treatment with heavy TRP. 5 points: good recovery, the patient returns to normal full-fledged life (a minor neurological deficit that does not affect the quality of life can be maintained); . 4 points: moderate disability - functionality is somewhat higher than just the ability to self-service (can use public transport, perform simple work, maintain yourself); . 3 points: Rough disablement - a patient in consciousness, but cannot fully serve himself. 2 points: chronic vegetative state - the patient does not speak, does not react to others, can open eyes, there are sleep / wake cycles; . 1 score: death (most of deaths directly related to heavy CMT arise during the first 48 h).

Z.butkrst.and I chere.pNabout- moz.g.ovaya T.ravma (withaboutt.ricen.e. G.tinn.aboutg.about moz.g.but, w.shiB G.tinn.aboutg.about moz.g.but, atn.w.t.r.chere.pNy g.e.ma.t.omi. and t.d.. )
TOoD etcaboutt.abouttoola: E-008.

C.e.l e.t.butpbut: Restoring the functions of all vital systems and organs

TOoD (toaboutd.s) pabout M.TOB.- 10 - 10:

S06.0 Brain concussion

S06.1 Traumatic brain swelling S06.2 Diffuse brain injury S06.3 Heat brain injury S06.4 Epidural hemorrhage

S06.5 Traumatic subdural hemorrhage

S06.6 Traumatic subarachnoid hemorrhage

S06.7 intracranial injury with a long comatose

S06.8 Other intracranial injuries

S06.9 intracranial injury uncomputed

OPRfoodl.e.n.e.: Z.butkrst.and Ichere.pNabout- moz.g.ovayat.ravma(ZCHMT) - damage to the skull and

the brain, which is not accompanied by a violation of the integrity of soft tissues of the head and / or aponeurotic stretching of the skull.

TO aboutt.krst.oh C.M.T. There are damages that are accompanied by a violation of the integrity of soft tissues of the head and the aponeurotic helmet of the skull and / or

correspond to the zone of the fracture. The penetrating damage belongs to such a CMT,

which is accompanied by fractures of the bones of the skull and damage to the solid brain

brain shells with the occurrence of liquor fistulas (lycvorea).

TOlasSandf.iKbutq.i:

According to Pathophysiology, TWF:

- Pe.ratandc.n.y- damage due to direct impact

traumatic forces on the skull bones, brain shells and brain tissue, brain vessels and a liquor system.

- ATt.aboutr.c.n.y - damage is not related to direct damage to the brain, but are due to the consequences of the primary damage to the brain and develop mainly

the type of secondary ischemic changes in cerebral tissue. (intracranial and system).

1. atn.w.t.r.chere.pNy - cerebrovascular changes, disorders of liquorocirculation,

brain swelling, intracranial pressure changes, dislocation syndrome.

2. withandwitht.e.m.n.y - arterial hypotension, hypoxia, hyper- and hyperials, hyper- and

hyponatremia, hyperthermia, impaired carbohydrate exchange, DVS syndrome.

By t.ij.e.witht.and withaboutwitht.oLAn.i bolbn.oh with C.M.T. – based on an assessment of the degree of oppression

consciousness of the victim, presence and severity of neurological symptoms, presence or absence of damage to other organs. The largest distribution was the scale of Glasgow's coma (proposed by G. Teasdale and B. Jennet 1974). The condition of the victims is estimated at first contact with the patient, after 12 and 24 hours in three parameters: opening the eye, speech response and motor reaction in response to external irritation. Allocate the classification of disorders of consciousness at CMT, based on a qualitative assessment of the degree of oppression of consciousness, where the following gradations of the state of consciousness are existed:

Moderate stunning;

Deep stunning;

Sopor;

- moderate coma;

Deep coma;

Foreign coma;
The Light SCMT includes the concussion of the brain and the bruise of the brain of easy degree. SCMT of moderate severity - the injury of the brain of medium severity. The heavy SCMT includes a severe brain injury and all types of brain compression.

ATsdelayut. 5 g.butd.butq.j. withaboutwitht.oLAn.i bol.bn.oh with C.M.T.:

1. uDaboutvLeT.ator.thoseflaskaboute.;

2. withrelfn.e.j. dragj.eUti;

3. dragj.e.l.aboute.;

4. toparadisen.e. dragj.e.l.aboute.;

5. thoserMIn.butflaskaboute.;

TOr.t.e.r.yami. w.d.oVLe.t.ataboutr.t.e.l.bn.aboutg.about withaboutwitht.oLAn.andi representedyut.sia:

1. yasn.oE withaboutz.n.butn.ande.;

2. abouttsutstatiE N.aRw.she.n.iY atandt.butln.sh. F.w.n.to;

3. abouttsutstatiE att.or.cNoh(d.andwithl.abouttoacionN.oh) n.e.atrOl.aboutg.andc.eUtoohwithimp.t.omart.andtoand abouttsutstati.l.and N.e.re.z.toand Iyourbutj.e.nN.aboutwitht. pe.ratandjnx Pl.w.shaRn.sx I. tor.n.and aboutb.butz.butflaxwithimp.t.omo.at. W.g.rOz.butd.l.i j.andz.n.and abouttsutstatyE.t, prog.n.oz ataboutcSTbutn.aboutvLe.n.and I t.ruDaboutwithbywithaboutb.n.aboutwithty O.b.ychnabout h.oro.shiy.

TOr.t.e.r.yami. withaboutwitht.aboutin.i withrelfn.e.j. t.ij.eUt.and representedyut.sia:

1. Clear consciousness or moderate stunning;

1-3 weeks after injury. The brain injury is easy to gravity may be accompanied by fractures of the bones of the skull.

4. W.shandb. g.tinn.aboutg.about moz.g.but withrelfn.e.j. witht.e.pe.n.and t.ij.e.witht.and. The loss of consciousness lasts from several tens of minutes to 2-4 hours. Oppression of consciousness to moderate or

deep stun can persist for several hours or days.

There is a pronounced headache, often re-vomiting. Horizontal

nistagm, weakening the reaction of pupils into the light, possibly disruption of convergence. There is a dissociation of tendon reflexes, sometimes moderate hemiparesis and pathological reflexes. There may be impairment of sensitivity, speech disorders. Meningkeal syndrome is moderately expressed, and the liquor pressure is moderately increased (with the exception of victims, which have Likvorea).

There is tachy or bradycardia. Breathing disorders in the form of a moderate tachipne without disturbing rhythm and does not require hardware correction. Subfebrile temperature. In the 1st day there may be psychomotor excitation, sometimes convulsive seizures. There is retro and anterorograd amnesia.

W.shandb. moz.g.but t.ij.e.loy witht.e.pe.n.. The loss of consciousness lasts from several hours to

a few days (in part of patients with the transition to Apallicic syndrome or akinetic mutation). Infertility of consciousness to a spin or coma. There may be a pronounced psychomotor excitation that replaced atonia. Stem symptoms are expressed - floating movements of the eyeballs, the difference of eyeballs along the vertical axis, fixing the look down, anisocorium. The reaction of pupils for light and corneal reflexes are depressed. Swallowing is broken. Sometimes the city of pain irritation or spontaneously develops. Bilateral pathological stop reflexes. There are changes in muscle tone, often hemiparez, anisaneflexia. There may be convulsive seizures. Breathing disorder - on a central or peripheral type (tachy or bradypnee). Blood pressure or elevated, or reduced (may be normal), and in an atonic coma is unstable and requires constant medical support. Meningkeal syndrome is expressed.

To the special form of brain bruises d.andfFultrasoundn.oE buttowithaboutn.butl.bn.oE poVre.j.deniemoz.g.but. Its clinical signs include a violation of the function of the brain barrel - the oppression of consciousness to a deep coma, a pronounced violation of the vital functions that require mandatory drug and hardware correction. Mortality in diffuse axonal brain damage is very high and reaches 80-90%, and the survivors develop appealic syndrome. Diffuse of axonal damage may be accompanied by the formation of intracranial hematomas.

5. WITH d. but at l. e. n. e. m. about z. g. but (growing and unlatenizing ) – happens at the expense

reduction of intracranial space with volume formations. It should be borne in mind that any "unlatenizing" compression of the CMT can become increasing and lead to severe compression and dislocation of the brain. The unlatenizing compresses include grinding bones of skull with indulged fractures, pressure on the brain by other foreign bodies. In these cases, the comprehensive brain itself is not increasing in volume. In the genesis of the brain compression, secondary intracranial mechanisms play a leading role. The growing compresses include all types of intracranial hematomas and brain bruises, accompanied by mass effect.

AT n. w. t. r and che r e. pm e. g. eat but t. about m. s :

1. Epidural;

2. subdural;

3. intracerebral;

4. intraventrices;

5. Multiple subordinate hematomas;

6. Subdural hydromes;

Hematomas can be: sharp (first 3 days), subacute (4 days-3 weeks) and

chronic (later 3 weeks).

The classic clinical picture of intracranial hematomas includes availability.

light gap, anisocoria, hemiparesis, bradycardia, which meets less often. The classic clinic is characteristic of a hematoma without a concomitant bruise of the brain. In victims with hematomas, in combination with the brain injury, from the first hours of CHMT, there are signs of primary damage to the brain and the symptoms of the compression and dislocation of the brain due to the injury to the brain tissue.

F. but to t. about r s r and with to but p r and FM. T. :

1. Alcoholic intoxication (70%).

2. CMT as a result of an epileptic attack.
ATelfw.shande. forc.iN.s C.M.T.:

1. Road injury;

2. Household injury;

3. fall and sports injury;

D.andbutgNaboutwitht.andschki.e. cRt.e.r.and: Pay attention to the presence of visible damage

scalp skin. Periorbital hematoma ("Symptom of Points", "Eyes of the Raccoon") indicates a fracture of the bottom of the front cranial fossa. The hematoma in the departure process (symptom of Battla) accompanies the pyramid of the temporal bone. Hemoccuspanum or break drumpatch It may correspond to the fibement of the base of the skull. The nose or earrings is indicated by the fracture of the base of the skull and penetrating CMT. The sound of the "cracked pot" during the percussion of the skull may occur during fractures of the bones of the skull of the skull. Exophthalm with swelling conjunctiva may indicate the formation of carotoid-cavernous calf or on the resulting retrobulbar hematoma. The hematoma of soft tissues in the occiput and cervical region can accompany the fibust of the occipital bone and (or) the bust of the poles and the basal departments of the frontal fractions and the poles of temporal fractions.

Undoubtedly, the assessment of the level of consciousness, the presence of meningeal

symptoms, the state of pupils and their reaction to the light, the functions of the cranial nerves and motor functions, neurological symptoms, an increase in intracranial pressure, the dislocation of the brain, the development of acute liquor occlusion.

T.buttot.iKbut abouttoazbutn.i m.elficycwithtoaboutj. pomo.shand:

The choice of the tactics of the treatment of victims determine the nature of the brain damage, the bones of the arch and the base of the skull, concomitant by the exchancing injury and

the development of complications due to injury.

ABOUTwithn.oVn.and I behindd.butc.but etcand abouttoaza.n.and pe.rhowling poh.aboutshand paboutwitht.rbutd.butatshandm. with chmt - prevent

development of arterial hypotension, hypoventilation, hypoxia, hyperkapinia, since these complications lead to severe ischemic brain lesions and accompanied by high mortality.

5. In psychomotor excitation, cramps and as premedication:

0.5-1.0 ml of 0.1% of the atropine solution subcutaneously;

Intravenously propofol 1-2 mg / kg, or sodium thiopental 3-5 mg / kg, or 2-4 ml 0.5%

sedukesen solution, or 15-20 ml of 20% sodium solution of oxybutirate, or Dormicum 0.1-

During transportation, the respiratory rhythm is needed.

6. With intracranial hypertensive syndrome:

2-4 ml of 1% furosemide solution (lazix) intravenous (with decomposed

bloodworp due to combined injury lAZiKwith N.e. vVOd.andt.b! );

Artificial hyperventilation of the lungs.

7. With pain syndrome: intramuscularly (or intravenously slowly) 30mg-1.0 ketorolac and 2 ml of 1-2% of the solution of diphedrol and (or) 2-4 ml (200-400 mg) 0.5% of the resistance of the tram or another non-market Analgesic in the appropriate doses.

OPIbutt.s n.e. vVOd.andt.b!

8. When wounds of the head and outdoor bleeding of them:

Wire toilet with edges treatment with antiseptic (see ch. 15).

9. Transportation to the hospital where there is an neurosurgical service; With a critical condition - in the intensive care unit.

Pe.rdesignn.b aboutwithn.oVn.oh m.elfiKaMe.n.t.s:

1. * Dopamine 4% 5 ml; amp

2. Dobutamine solution for infusion 5 mg / ml

4. * Prednisolone 25mg 1ml, AMP

5. * Diazepam 10 mg / 2 ml; amp

7. * Sodium oxybat 20% 5 ml, AMP

8. * Magnesium sulfate 25% 5.0, AMP

9. * Mannitol 15% 200 ml, FL

10. * Furosemid 1% 2.0, AMP

11. Meston 1% - 1.0; amp

Pe.rdesignn.b d.aboutpoL.n.andt.e.l.bn.oh m.elfiKaMe.n.t.oV:

1. * Atropine sulfate 0.1% - 1.0, AMP

2. * Betamethasone 1ml, AMP

3. * Epinephrine 0.18% - 1 ml; amp

4. * Destrane 70 400.0; FL

5. * Diphenhydramine 1% - 1.0, AMP

6. * Ketorolak 30mg - 1.0; amp

WITHp.withoK andwithpaboutl.bzovanN.oh l.andt.e.rbutt.w.rs:

1. "Nervous System Diseases" / Guide for Doctors / Edited by N.N. Yell

D.R. Stylman - 3rd edition, 2003

2. V.A. Mikhailovich, A.G. Miroshnichenko. Guide for emergency medical devices. 2001

4. Birtanov E.A., Novikov S.V., Akshalova D.Z. Development clinical guides and diagnostic and treatment protocols taking into account modern requirements. Methodical

No. 883 "On approval of a list of basic (vital) medicines."

"On approval of instructions for the formation of a list of basic (vital)

medicines. "

WITHp.withoK razrab.aboutt.c.iKs:

Head of the Department of Emergency and Emergency Medical Aid, internal Diseases No. 2 of the Kazakh National Medical University. S.D.

Asphendiyarova - D.M., Professor Turlanov KM Employees of the Department of Emergency and Emergency Medical Aid, internal Diseases No. 2 of the Kazakh National

medical University. S.D. Asphendiyarova: Ph.D., Associate Professor Vodnev VP; Ph.D.,

associate Professor Dyasebev B.K.; K.M.N., Associate Professor Akhmetova G.D.; Ph.D., Associate Professor Babybaeva G.G.;

Almukhambetov MK; Laskin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of Almaty State

institute for Improvement Doctors - Ph.D., Associate Professor Rakhimbaev R.S. Employees of the Department of Emergency Medicine of the Almaty State Institute of Improvement of Doctors: Ph.D., Associate Professor Solchev Yu.I.; Volkova N.V.; Hairulin R.Z.; Sedrenko V.A.

* - Preparations included in the list of basic (vital drugs) drugs

heat Cord Contusion (S06.3)

Excluded:

decapitation (S18)
eye injury and soccer (S05.-)
traumatic amputation of the head of the head (S08.-)

Note. In the primary statistical development of fractures of the skull and facial bones, combined with intracranial injury, it is necessary to be guided by the rules and instructions for encoding the incidence and mortality set forth in Part 2.

The following subheadings (fifth sign) are given for optional use when additional characteristic states when it is impossible or inappropriate to carry out multiple coding to identify a fracture or an open wound; If the fracture is not characterized as open or closed, it should be classified as closed:

open wound of century and a near-eyed area (S01.1)

Note. In the primary statistical development of intracranial injuries, combined with fractures, it is necessary to be guided by the rules and instructions for encoding morbidity and mortality set forth in Part 2.

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, the reasons for the appeals of the population in medical institutions All departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Classific Brain Injury Classification

Classification of the cranial injury -.

code for insertion on the forum:

Classification of the cranial injury on the ICD-10

S06 intracranial injury

Note: With the primary statistical development of intracranial injuries, combined with fractures, it is necessary to be guided by the rules and instructions for encoding the incidence and mortality set forth in part 2.

The following subheadings (fifth sign) are given for optional use with an additional characteristic of the state, when it is impossible or inappropriate to carry out multiple coding to identify intracranial injury and an open wound:

0 - without an open intracranial wound
1 - with an open intracranial wound

S06.9 intracranial injury uncomputed
Excluded: Head Injury BDU (S09.9)

S07 Head Discharge

S07.0 Discharge facial
S07.1 Spotchape scraps

Exclosed: decapitation (S18)

Clinical classification of acute acute brain injury [Konovalov A.N. et al., 1992] *

brain concussion;
brain injury easy degree;
middle-degree brain injury;
injury brain injury;
diffuse axonal brain damage;
brain compression;
head squeezing.

* Konovalov A.N., Vasin N.Ya., Lighterman L.B. and etc. Clinical classification acute acute brain injury // Classification of cranial injury. - M., 1992. - P. 28-49.

Investigation of damage to the bones of the skull in the experiment at dosage strikes / Gromov A.P., Antufyev I.I., Saltykova O.F., Skypnik V.G., Boltsov V.M., Balonkin G.S., Lemolas V.B. ., Maslov A.V., Velmkovich N.A., Krasnoyy I.G. // Forensic-medical examination. - 1967. - №3. - P. 14-20.

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Ochmt Code ICD 10

1049 universities, 2211 items.

Closed cranial trauma (concussion of the brain, injury

Purpose of the stage: Restoring the functions of all vital systems and organs

S06.0 Brain concussion

S06.1 Traumatic brain swelling

S06.2 Diffuse brain injury

S06.3 Heat brain focal injury

S06.4 Epidural hemorrhage

S06.5 Traumatic subdural hemorrhage

S06.6 Traumatic subarachnoid hemorrhage

S06.7 intracranial injury with a long comatose

S06.8 Other intracranial injuries

S06.9 intracranial injury uncomputed

Definition: Closed Card and Brain Injury (ZCHMT) - Damage to the skull and

brain, which is not accompanied by a violation of the integrity of soft tissues of the head and / or

uponework stretching skull.

The open CMT includes damages that are accompanied by a violation

the integrity of the soft tissues of the head and the aponeurotic helmet of the skull and / or corresponding

wash the fracture zone. The penetrating damage includes such a CMT that has

widges the fractures of the bones of the skull and damage to the solid brain sheath with

the occurrence of liquor fistulas (lycvorea).

Primary - damage due to direct exposure to injuries

powered skull bones, brain shells and brain tissue, brain vessels and liquor

Secondary - damage not related to direct brain damage,

but due to the consequences of primary brain damage and develop mainly

by type of secondary ischemic changes in cerebral tissue. (intracranial and systems-

1. intracranial - cerebrovascular changes, violations of liquorocyer

liances, brain swelling, changes in intracranial pressure, dislocation syndrome.

2. Systemic - arterial hypotension, hypoxia, hyper- and hypermings, hyper- and

hyponatremia, hyperthermia, impaired carbohydrate exchange, DVS syndrome.

In the severity of the patients with CMT - is based on the evaluation of the degree of coal

the consciousness of the victim, the presence and severity of neurological symptoms,

licacy or absence damage to other organs. The greatest distribution of

chila Glasgow Coma (proposed by G. Teasdale and B. Jennet 1974). Status

giving evaluated at the first contact with the patient, after 12 and 24 hours in three parameters

ram: opening the eye, speech response and motor reaction in response to the external

dragoncy. Allocate the classification of disorders of consciousness at CMT, based on

evaluating the degree of oppression of consciousness, where the following gradations exist

The Light ZChMT includes the concussion of the brain and the brain bruise easy

degree. SCMT of moderate severity - the injury of the brain of medium severity. To

zhelya ZCHMT belongs to the injury of the brain of severe and all types of headings

2. Middle severity;

4. Extremely severe;

Satisfactory condition criteria are:

1. Clear consciousness;

2. No violations of vital functions;

3. Lack of secondary (dislocation) neurological symptoms, absence

ordinary severity of primary semi-coarse and crani-bean symptoms.

There is no threat to life, the displacement of disability is usually good

The criteria of the state of moderate gravity are:

1. Clear consciousness or moderate stunning;

2. Vital functions are not violated (only bradycardia is possible);

3. Focal symptoms - can be expressed by certain half-and-old and crane

basal symptoms. Sometimes single, gently expressed stem

symptoms (spontaneous Nistagm et al.)

To establish the state of moderate severity is enough to have one of

specified parameters. The threat to life is insignificant, the forecast of the restoration of labor

abilities are more likely favorable.

1. Changes in consciousness to deep stunning or spin;

2. Violation of the vital functions (moderate one by one - two indicators);

3. Focal symptoms - stem are moderately expressed (anisocorium, light limitation

rejecting a look up, spontaneous nystagm, contralateral pyramidal failure

the dissociation of meningeal symptoms along the body axis, etc.); can be sharply

wives of half and cranified symptoms, including epileptic seizures,

pares and paralysis.

To establish a difficult state, it is permissible to have these disorders.

would one of the parameters. The threat to life is significant, largely depends on

severe states, disgraceability of ability to restore disability

1. Violation of consciousness to moderate or deep coma;

2. A sharply pronounced violation of the vital functions in several parameters;

3. Focal symptoms - stem are expressed clearly (parires of the gaze up, expressed

anisocorium, eye divergence vertical or horizontal, tonic spontaneous

nistagm, weakening the reaction of pupils into light, bilateral pathological reflexes,

decerebraction rigidity, etc.); Half and cranified symptoms sharply

expressed (up to bilateral and multiple paresis).

When establishing an extremely severe state, it is necessary to have pronounced

in all respects, and one of them is necessarily the limit, threat for

maximum life. Forecast displacement is more often unfavorable.

Terminal state criteria:

1. Violation of consciousness to the level of the coma;

2. Critical violation of vital functions;