Traumatic brain injury: features, consequences, treatment and rehabilitation. Injuries. Other types of injuries

A closed head injury can have the most dire consequences for a person, which is why timely diagnosis and treatment is so important. Rehabilitation after TBI can be done at the Three Sisters Center.

According to inexorable statistics, up to 50% of all injuries are caused by skull injuries, and in 20% of cases this is a serious injury, often leading to the death or disability of the victim. Up to 60% of those who have received severe craniocerebral injuries die within 2-3 years after the injury due to a cause somehow related to it.

As is known from the ICD-10 code, craniocerebral injuries are classified into open and closed. The former are characterized by a violation of the integrity of the scalp, skull bones, aponeurosis and, often, damage to the medulla (in the latter case, the wound is defined as penetrating). With closed injuries, either there is no damage to the integument (for example, concussion), or injury to soft tissues or bone is observed, but without rupture of the aponeurosis. In this case, there is usually no need to be afraid of sepsis, since the intracranial cavity retains its "closedness". However, one should not underestimate closed injuries - sometimes they are more dangerous than open ones, not least because they are not given due importance and treatment is delayed.

Causes and consequences of CCI and concussions

Factors that cause TBI can be of various kinds: car accidents and other accidents, falls, blows to the head, mechanical damage caused by another person (intentionally or accidentally). The consequences of such damage can be extremely serious, up to and including death. There are frequent cases of paresis of the extremities, pinched nerves, loss of cognitive functions of the brain.

Symptoms of closed TBI of various types

Doctors share the symptoms of craniocerebral injuries that occur immediately after injury and "delayed" symptoms that can be noticed only after a few hours, or even days. Even if there are no visible signs of injury (for example, an open wound), it is possible to assume the presence of injury by the following symptoms:

Loss of consciousness is the most bright sign... It can last from several minutes to several days. It is observed during concussion, contusion (contusion), compression (hematoma) of the brain.
Nausea and vomiting are common symptoms of a concussion.
Dizziness, headaches are a symptom that can be observed both with trauma and with a stroke or other disorders of the brain.
Pallor or redness of the face is observed with bruises and brain contusion.
Photophobia may indicate traumatic subarachnoid hemorrhage.
Violation of speech indicates a focal lesion of the brain (hematoma, hemorrhage).
Hematomas on the skin (usually around the eyes and behind the ear), as well as the outflow of blood or cerebrospinal fluid from the ears, are a sign of a fracture of the vault or base of the skull. Strictly speaking, this injury is more likely to be open, but some classifications include it in closed.

There are three periods of craniocerebral trauma: acute (sometimes considered separately the most acute - within an hour or two after injury), intermediate and distant. First aid measures should be taken immediately, and treatment should be started without waiting for the end of the acute period.

Diagnostics and treatment of closed craniocerebral injuries

To confirm the diagnosis by medical history, use different methods diagnostics: examination by a neurologist, traumatologist or neurosurgeon, computed and magnetic resonance imaging, echoencephalography, lumbar puncture (if brain compression is suspected), craniography.

Depending on the data obtained on the severity and nature of the injury, the doctor prescribes inpatient treatment.

In severe injuries, measures are taken to maintain breathing. If necessary, urgent surgical intervention is performed (for hematomas and hemorrhages). It is important to immobilize the patient, to prevent seizures, which can aggravate the condition of the injured person.

A complex of drug therapy is also carried out, including:

dehydration drugs: lasix, furosemide (with prolonged administration, they are additionally prescribed potassium chloride, panangin);
glucose solution, magnesia;
analgesic drugs: baralgin, analgin, etc.;
coagulants: calcium gluconate, askorutin, etc .;
sedatics;
anticonvulsants;
if necessary - antibiotics, antipyretic;
after the end of the acute period, B vitamins are prescribed.

The duration of conservative treatment is determined individually and depends on the patient's recovery rate. During the entire stay in the hospital, additional therapy is carried out with the patient: massage, passive, and then active gymnastics, breathing exercises.

Come to Three Sisters and we will take care of your health.

Traumatology is the science of damage to human organs and tissues. She is engaged in the study of injuries, its prevention, the organization of trauma care and the treatment of injuries of the musculoskeletal system.

Trauma, or damage, is a sudden effect of environmental factors (mechanical, thermal, chemical, etc.) on tissues, organs or the body as a whole, leading to anatomical and physiological changes, accompanied by a local and general reaction of the body.

Damage, depending on the application of force, is divided into direct and indirect. They are isolated - with damage to one anatomical and functional formation of the musculoskeletal system; multiple - with damage to two or more anatomical and functional formations or damage to blood vessels and nerves in various segments of the limbs; combined - damage to internal organs in various cavities with trauma to the musculoskeletal system - and combined - the simultaneous presence of two etiologically dissimilar injuries in the victim (for example, fracture of the humerus and body burns).

The mechanical factor can manifest itself in the form of pressure, stretching, rupture, torsional moment of force application, or a counter-shock. In this case, the force of the impact of an external factor on tissues and organs is directly proportional to the direction (directly or at an angle), the speed and duration of the impact, which leads to varying degrees of injury severity. The most common injuries include bruises, wounds, dislocations, bone fractures, limb tears, burns, frostbite, electrical injuries, etc.

TO bruises(contusio) include mechanical damage to tissues or organs, often without violating the integrity of the skin. In this case, the subcutaneous fatty tissue is destroyed, and hemorrhages occur with impaired arterial, venous circulation and lymph flow. There is swelling of soft tissues, an increase in local temperature, redness of the skin (reactive hyperemia). In case of bruises in the area of the limbs with the involvement of muscles, tendon-ligamentous apparatus, joints, the musculoskeletal function is impaired, with bruises of organs (heart, lung, brain, etc.), functions specific to these organs are impaired. The severity of the injury depends on the strength of the external influence and the localization of the damaged tissues and organs.

Compression(compressio)- damage to organs or tissues caused by pressure from the outside or from neighboring organs or tissues. A serious danger to life is compression of the brain (hematoma, edema, tumor), heart (hemopericardium), lungs (hemothorax, pneumothorax). Into a separate nosological group long-term compression of the soft tissues of the extremities, less often of the trunk, is distinguished, while a syndrome of prolonged compression (crushing), or crash syndrome, occurs. In its development, the main role is played by traumatic toxicosis caused by decay products and impaired metabolism of compressed or crushed soft tissues.

The severity of the condition of the victims is aggravated by the development of acute renal failure.

Wound(vulnus)- any violation of the integrity of the skin or mucous membranes under the influence of external mechanical impact or internal impact - a bone fragment. Distinguish between superficial and deep wounds - with damage to large vessels, nerves, internal organs.

Dislocation(luxatio)- complete separation of the articular ends of the bones, with subluxation, partial contact of the articular surfaces remains, but with deformation of the contours of the joint and the joint space (excessive expansion, uneven narrowing, etc.). Distinguish between fracture dislocation (intra-articular fracture of the dislocated end of the bone) and dislocation of the bone with extra-articular fracture. The distally located bone is considered dislocated. Dislocation is considered fresh up to 3 days from the moment of injury, stale - up to 3 weeks, old - more than 3 weeks. On the etiological basis, dislocations are divided into traumatic, habitual, congenital and pathological. Traumatic Dislocations occur more often with indirect trauma with forced violent movement in the joint, exceeding the amplitude of its normal movements. Habitual Dislocation occurs mainly in the shoulder joint after an untreated or improperly treated primary traumatic dislocation. Repeated dislocations can occur with different frequencies due to minimal external violent influences and even normal movements in the joint with a large amplitude. Congenital dislocation is formed as a result of dysplasia (underdevelopment) of the joint. Predominant hip involvement has been and remains a serious orthopedic problem. Pathological dislocation is the result of destruction of the joint by any pathological process (arthrosis, tuberculosis, osteomyelitis, tumor).

The turning point(fractura ossis) is called damage to the bone with a violation of its integrity. Most fractures result from mechanical forces that exceed the strength of normal bone. Less often, a fracture occurs from minor efforts (from the weight of a limb, body) and is considered pathological (in the area of a tumor, cyst, inflammatory process). Most often, fractures are closed, less often (1:10) - open (the area of the fracture communicates with the wound). If the wound has arisen from external violence, then the fracture is considered primarily open. If the skin is perforated with a fragment (fragment) of the bone from the inside, then the fracture is considered to be secondary-open. This division is of fundamental importance, since in a primary open fracture, destruction of soft tissues and microbial aggression can significantly affect the surgical tactics and method of fracture treatment.

Traumatism- a social phenomenon, as a result of which certain groups of residents, who are in the same working and living conditions, are injured. There are the following types of injuries.

I. Industrial injuries.

1. Industrial.

2. Agricultural.

II. Non-work-related injuries.

1. Household.

2. Street:

a) transport;

b) non-transportable.

3. Sports.

III. Intentional injury (murder, suicide, self-harm).

IV. Military injuries.

V. Children's injuries.

1. Generic.

2. Household.

3. Street.

4. School.

5. Sports.

6. Other accidents.

Work injury arises from industrial accident when workers are exposed to various production factors. All employees are subject to compulsory social insurance against accidents and occupational diseases.

The causes of industrial accidents are divided into objective and subjective. TO objective reasons conditionally include technical and sanitary-hygienic, to subjective - organizational and psychophysiological.

TO technical reasons include equipment malfunction; inconsistent switching on of electricity and other energy sources; lack of a hazardous area fencing, etc.

TO sanitary and hygienic reasons include poor lighting; air pollution; increased radiation, etc.

Organizational reasons are the wrong organization of work; poor-quality instruction on labor protection issues; admission of unskilled workers to work of increased danger.

Psychological reasons fatigue and inattention during monotonous work; weakening of self-control; arrogance; unjustified, unlawful risk.

Up to 80% of accidents occur due to erroneous or late actions of employees. The main cause of accidents and injuries is the risk factor. The risk can be legitimate (acceptable) and unlawful (unacceptable).

Investigation and registration of accidents. All industrial accidents are subject to investigation:

during the performance of labor duties, as well as actions in the interests of the enterprise without the instructions of the employer;
at the workplace, on the territory of the enterprise or in another place of work during working hours, including established breaks;
while putting in order the tools of production, clothing before or after the end of work, as well as for personal hygiene;
on the way to or from work, including on our own transport used in the interests of production;
during accidents (fire, explosion, landslide) and their elimination at production facilities.

On an accident, as a result of which the employee, according to the medical report, lost his ability to work for one day or more, or it became necessary to transfer him to another, easier job for a period of at least one day, an act is drawn up in the form of N-1.

The head of the enterprise, having received a message about the accident, by order appoints a commission of investigation in the following composition: the head (specialist) of the labor protection service (chairman of the commission), the head of a structural unit or chief specialist, a representative of a trade union organization, a specialist in sanitary and epidemiological supervision (acute poisoning), an authorized labor team on labor protection.

The owner of the enterprise approves five copies of the act in the form of N-1 within 24 hours. One copy of act N-1, together with the investigation materials, is kept for 45 years at the enterprise, where the accident is registered. Copies of the act are kept until all measures are taken to eliminate and prevent a hazardous production factor.

Injury management is usually carried out in three areas:

1) prevention;

2) organization of trauma care;

3) qualified and specialized treatment.

This problem still remains one of the most acute problems in traumatology, since injuries annually claim a significant number of human lives, turn an even larger number of victims into invalids and thereby cause enormous moral and material damage to the state.

Traumatology and Orthopedics. N.V. Kornilov

Traumatic brain injury ranks first among all injuries (40%) and most often occurs with people aged 15–45 years. The mortality rate among men is 3 times higher than among women. In large cities, seven out of a thousand people every year receive craniocerebral injuries, while 10% die before reaching the hospital. In the event of a minor injury, 10% of people remain disabled, in the event of a moderate injury - 60%, severe - 100%.

Causes and types of traumatic brain injury

A complex of injuries to the brain, its membranes, skull bones, soft tissues of the face and head - this is a traumatic brain injury (TBI).

Most often, participants in road accidents suffer from head injuries: drivers, passengers of public transport, pedestrians hit by vehicles. In second place in terms of frequency of occurrence are household injuries: accidental falls, blows. This is followed by work-related injuries and sports injuries.

Young people are most susceptible to injuries during the summer - these are the so-called criminal injuries. The elderly are more likely to develop TBIs in winter, with falls from height becoming the leading cause.

Statistics
Residents of Russia most often get TBI in a condition drunkenness(70% of cases) and as a result of fights (60%).

One of the first to classify traumatic brain injury was proposed by the French surgeon and anatomist of the 18th century Jean-Louis Petit. Today there are several classifications of injuries.

by severity: easy(concussion, slight contusion), average(serious injury) heavy(severe contusion of the brain, acute compression of the brain). The Glasgow Coma Scale is used to determine the severity. The victim's condition is estimated from 3 to 15 points depending on the level of confusion, the ability to open the eyes, speech and motor reactions;
type: open(there are wounds on the head) and closed(there are no violations of the skin of the head);
by type of damage: isolated(only the skull is damaged) combined(the skull and other organs and systems are damaged), combined(the injury was received not only mechanically, the body was also affected by radiation, chemical energy, etc.);
by the nature of the damage:

shake(minor injury with reversible consequences, characterized by a short-term loss of consciousness - up to 15 minutes, most of the victims do not need hospitalization, after examination the doctor may prescribe CT or MRI);
injury(there is a violation of the brain tissue due to the impact of the brain on the wall of the skull, often accompanied by hemorrhage);
diffuse axonal brain injury(axons are damaged - the processes of nerve cells that conduct impulses, the brain stem suffers, microscopic hemorrhages are noted in the corpus callosum of the brain; such damage most often occurs during an accident - at the time of sudden inhibition or acceleration);
squeezing(hematomas form in the cranial cavity, the intracranial space is reduced, crush foci are observed; emergency surgical intervention is required to save a person's life).

It's important to know
Brain trauma most often occurs at the site of impact, but often damage occurs on the opposite side of the skull - in the area of the counter-impact.

The classification is based on the diagnostic principle, on its basis a detailed diagnosis is formulated, in accordance with which treatment is prescribed.

TBI symptoms

The manifestations of traumatic brain injury depend on the nature of the injury.

Diagnosis « brain concussion» is put on the basis of anamnesis. Usually, the victim reports that there was a blow to the head, which was accompanied by a short-term loss of consciousness and a single vomiting. The severity of the concussion is determined by the duration of loss of consciousness - from 1 minute to 20 minutes. At the time of examination, the patient is in a clear state, may complain of a headache. No abnormalities, except for pallor of the skin, are usually not detected. In rare cases, the victim is unable to remember the events preceding the injury. If there was no loss of consciousness, the diagnosis is made as doubtful. Within two weeks after a concussion, weakness, increased fatigue, sweating, irritability, and sleep disturbances may occur. If these symptoms persist long time, then it is worth revising the diagnosis.

At mild brain contusionand the victim may lose consciousness for an hour, and then complain of headache, nausea, vomiting. There is twitching of the eyes when looking to the side, asymmetry of reflexes. X-rays can show a fracture of the bones of the cranial vault, in the cerebrospinal fluid - an admixture of blood.

Dictionary
Liquor - liquid transparent color, which surrounds the brain and spinal cord and performs including protective functions.

Moderate brain contusion severity is accompanied by loss of consciousness for several hours, the patient does not remember the events preceding the injury, the injury itself and what happened after it, complains of headache and repeated vomiting. There may be: violations of blood pressure and pulse, fever, chills, soreness of muscles and joints, seizures, visual impairment, uneven size of the pupils, speech disorders. Instrumental studies show fractures of the cranial vault or base of the skull, subarachnoid hemorrhage.

At severe brain contusion the victim may lose consciousness for 1–2 weeks. At the same time, gross violations of vital functions (pulse rate, pressure level, respiratory rate and rhythm, temperature) are revealed in him. The movements of the eyeballs are uncoordinated, muscle tone is changed, the swallowing process is impaired, weakness in the arms and legs can reach convulsions or paralysis. As a rule, this condition is a consequence of fractures of the vault and base of the skull and intracranial hemorrhage.

It is important!
If you or your loved ones suspect that you have received a traumatic brain injury, it is necessary to see a traumatologist and neurologist within a few hours and carry out the necessary diagnostic procedures. Even if it seems that the state of health is in order. After all, some symptoms (cerebral edema, hematoma) may appear after a day or even more.

At diffuse axonal brain injury a prolonged moderate or deep coma occurs. Its duration ranges from 3 to 13 days. Most of the victims have a disorder of the respiratory rhythm, different arrangement of the pupils horizontally, involuntary movements of the pupils, arms with hanging hands bent at the elbows.

At compression of the brain two clinical pictures can be observed. In the first case, a "light period" is noted, during which the victim regains consciousness, and then slowly enters a state of stupor, which is generally similar to stunning and numbness. In another case, the patient immediately falls into a coma. Each of the conditions is characterized by uncontrolled eye movement, strabismus, and cross-paralysis of the limbs.

Long-term head compression accompanied by edema of soft tissues, reaching a maximum 2-3 days after its release. The victim is in psycho-emotional stress, sometimes in a state of hysteria or amnesia. Swollen eyelids, diminished vision or blindness, asymmetric facial edema, numbness in the neck and back of the head. Computed tomography shows edema, hematomas, fractures of the skull bones, foci of brain contusion and crush injury.

Consequences and complications of TBI

After suffering a traumatic brain injury, many become disabled due to mental disorders, movement, speech, memory, post-traumatic epilepsy and other reasons.

Even mild TBI affects cognitive functions- the victim experiences confusion and mental decline. In more severe injuries, amnesia, impairment of vision and hearing, speech and swallowing skills can be diagnosed. In severe cases, speech becomes slurred or even completely lost.

Motility and musculoskeletal disorders expressed in paresis or paralysis of the limbs, loss of body sensitivity, lack of coordination. In the case of severe and moderate injuries, there is failure of larynx closure, as a result of which food accumulates in the pharynx and enters the respiratory tract.

Some TBI survivors suffer from pain syndrome- acute or chronic. Acute pain syndrome persists for a month after injury and is accompanied by dizziness, nausea, and vomiting. Chronic headache accompanies a person throughout his life after receiving a TBI. The pain can be sharp or dull, throbbing or pressing, localized or radiating, for example, to the eyes. Pain attacks can last from several hours to several days, and intensify during moments of emotional or physical stress.

Patients are seriously worried about the deterioration and loss of body functions, partial or complete loss of working capacity, therefore, they suffer from apathy, irritability, depression.

TBI treatment

A person who has received a head injury needs medical help. Before the arrival of an ambulance, the patient should be laid on his back or on his side (if he is unconscious), a bandage should be applied to the wounds. If the wound is open, cover the edges of the wound with bandages, and then apply a bandage.

The ambulance team takes the victim to the traumatology department or to the intensive care unit. There the patient is examined, if necessary, an X-ray of the skull, neck, thoracic and lumbar spine, chest, pelvis and extremities is done, an ultrasound of the chest and abdominal cavity is performed, blood and urine are taken for analysis. An ECG may also be prescribed. In the absence of contraindications (state of shock), CT of the brain is done. Then the patient is examined by a traumatologist, surgeon and neurosurgeon and diagnosed.

A neurologist examines the patient every 4 hours and assesses his condition on the Glasgow scale. In case of impaired consciousness, the patient is shown tracheal intubation. A patient in a state of sopor or coma is prescribed artificial ventilation lungs. Patients with hematomas and cerebral edema are regularly measured intracranial pressure.

The victims are prescribed antiseptic, antibacterial therapy. If necessary, anticonvulsants, analgesics, magnesia, glucocorticoids, sedatives.

Patients with hematoma require surgery. Delaying surgery within the first four hours increases the risk of death by up to 90%.

Recovery prognosis for TBI of varying severity

In the event of a concussion, the prognosis is favorable, provided that the injured person follows the recommendations of the attending physician. Full recovery of working capacity is observed in 90% of patients with mild TBI. In 10%, cognitive functions remain impaired, as well as a sharp change in mood. But even these symptoms usually disappear within 6-12 months.

The prognosis for moderate and severe TBI is based on the number of points on the Glasgow scale. An increase in points indicates a positive trend and a favorable outcome of the injury.

In patients with moderate TBI, it is also possible to achieve full restoration of body functions. But headaches, hydrocephalus, vegetative-vascular dysfunction, coordination disorders and other neurological disorders often remain.

In severe TBI, the risk of death increases to 30–40%. Among the survivors, there is almost one hundred percent disability. Its causes are severe mental and speech disorders, epilepsy, meningitis, encephalitis, brain abscesses, etc.

Of great importance in the patient's return to an active life is a complex of rehabilitation measures provided in relation to him after the acute phase was stopped.

Directions of rehabilitation after traumatic brain injury

World statistics show that $ 1 invested in rehabilitation today will save $ 17 to ensure the victim's life tomorrow. Rehabilitation after TBI is carried out by a neurologist, a rehabilitologist, a physical therapist, an occupational therapist, a massage therapist, a psychologist, a neuropsychologist, a speech therapist and other specialists. Their activity, as a rule, is aimed at returning the patient to a socially active life. The work to restore the patient's body is largely determined by the severity of the injury. So, in case of severe trauma, the efforts of doctors are aimed at restoring the functions of breathing and swallowing, at improving the functioning of the pelvic organs. Also, specialists are working on the restoration of higher mental functions (perception, imagination, memory, thinking, speech) that could have been lost.

Physical therapy:

Bobath therapy involves stimulating the patient's movements by changing the positions of his body: short muscles are stretched, the weak are strengthened. People with movement disabilities get the opportunity to master new movements and hone the learned ones.
Vojta Therapy helps link brain activity and reflex movements. The physical therapist irritates different parts of the patient's body, thereby prompting him to make certain movements.
Mulligan therapy helps relieve muscle tension and pain relief movements.
Installation "Exart" - suspension systems with which you can relieve pain and return to work atrophied muscles.
Trainings on simulators. Exercises are shown on cardiovascular machines, biofeedback machines, as well as on a stabiloplatform - for training coordination of movements.

Occupational therapy- direction of rehabilitation, which helps a person to adapt to environmental conditions. The occupational therapist teaches the patient to take care of himself in everyday life, thereby improving the quality of his life, allowing him to return not only to social life, but even to work.

Kinesio taping- application of special adhesive tapes to damaged muscles and joints. Kinesitherapy helps to relieve pain and swelling without restricting movement.

Psychotherapy- an integral part of quality recovery after TBI. The psychotherapist conducts neuropsychological correction, helps to cope with apathy and irritability inherent in patients in the post-traumatic period.

Physiotherapy:

Medicinal electrophoresis combines the introduction of drugs into the victim's body with exposure to direct current... The method allows you to normalize the state nervous system, improve blood supply to tissues, relieve inflammation.
Laser therapy effectively fights pain, tissue edema, has anti-inflammatory and reparative effects.
Acupuncture can reduce pain. This method is included in the complex of therapeutic measures in the treatment of paresis and has a general psychostimulating effect.

Drug therapy is aimed at preventing brain hypoxia, improving metabolic processes, restoring active mental activity, and normalizing the emotional background of a person.

After moderate and severe traumatic brain injuries, it is difficult for the victims to return to their usual way of life or to come to terms with the forced changes. In order to reduce the risk of developing serious complications after TBI, it is necessary to follow simple rules: do not refuse hospitalization, even if it seems that the state of health is in order, and do not neglect various types of rehabilitation, which, with an integrated approach, can show significant results.

Which rehabilitation center after TBI can I contact?

“Unfortunately, there is no single program of rehabilitation after craniocerebral trauma that would allow the patient to return to his previous state with a 100% guarantee, - says a specialist at the rehabilitation center. - The main thing to remember: with TBI, a lot depends on how soon rehabilitation measures are started. For example, "Three Sisters" accepts victims immediately after hospitalization, we provide assistance even to patients with stomas, bedsores, we work with the smallest patients. We receive patients 24 hours a day, seven days a week and not only from Moscow, but also from the regions. We devote 6 hours a day to rehabilitation classes and continuously monitor the dynamics of recovery. Our center employs neurologists, cardiologists, neuro-urologists, physical therapists, occupational therapists, neuropsychologists, psychologists, speech therapists - all of them are experts in rehabilitation. Our task is to improve not only physical condition victim, but also psychological. We help a person to gain confidence that, even after suffering a severe trauma, he can be active and happy. "

Injuries, according to statistics, account for 9% of the total number of deaths worldwide. This is one of the most common reasons for patients being admitted to hospital and seeking medical attention. A significant proportion of patients who survived severe trauma receive temporary or permanent disability.

A sudden, short-term or long-term effect on tissues / organs, resulting in anatomical and physiological changes of varying degrees, is called trauma. This effect, depending on the type of damaging factor, can be different, in particular, mechanical, chemical, etc. The causes of injuries are manifold. For example, a mechanical factor can be pressure, rupture, stretching, etc. Electrical injury occurs as a result of tissue contact with an electric current, and as a result of interaction with open fire or high-temperature liquids. Separately, it is worth noting chemical burns, which are possible upon contact with aggressive chemicals. The severity of the injury depends on the speed and duration of the external stimulus. Many injuries require urgent medical attention, and the prognosis for patients depends on the timeliness of treatment started.

What is Injury?

Injury is a term that implies the prevalence of various types of injuries among certain groups of people living in approximately the same conditions, both at home and at work. According to statistics, among the male population, injuries most often occur between 20-49 years, and among the female - between 30 and 59 years. Moreover, at any age, men are more susceptible to injury than women. Injury is the third most common cause of death and primary disability. It is also worth noting that in terms of mortality rates, injuries rank first among people of working age.

Huge efforts are currently being made to study the causes of injury and the causes of its occurrence, the frequency of various types of injuries, their nature, as well as the peculiarities of the existence of certain groups of people. According to summarized data, approximately 6% of the population is exposed to various types of damage per year.

Exists different kinds injuries:

occupational injuries, divided into industrial and agricultural;
non-production, including street, household and sports;
deliberate injury arising against the background of illegal actions of one person in relation to another in order to injure him or take his life;
military injuries, the name of which speaks for itself and implies injury due to hostilities or in the service;
children, including childbirth (injuries received during childbirth), street, household, school, sports and injuries associated with various accidents.

Accidents at various enterprises are often the cause of work-related injuries. That is why social insurance for manufacturing enterprises for every employee is mandatory. This insurance covers various industrial accidents and so-called occupational diseases. The reasons for getting work-related injuries can be:

Objective, in particular technical and sanitary and hygienic.

The former include the malfunctioning state of the equipment used, unexpected power outages, improper arrangement working area etc. Among the sanitary and hygienic reasons, it is worth noting poor lighting and polluted air at the enterprise, an increased level of radiation, etc.

Subjective.

These include mainly the organizational and psychological causes of trauma. Organizational reasons for which an occupational injury may occur are the illiterate distribution of the work process, the absence or non-observance of established rules, the involvement of unskilled employees in especially hazardous work. Psychological reasons are purely individual. These include employee arrogance, weakening of self-control, inattention, fatigue, etc.

According to statistics, approximately 80% of industrial injuries are the result of erroneous and untimely actions of employees. The negligent attitude of the management of the enterprise and its employees themselves creates dangerous working conditions and increases the likelihood of injury. The following cases are being officially investigated:

during working hours directly at the enterprise itself or in another place where the employee fulfills his work obligations;
when fulfilling the duties indicated by the employer;
when putting work equipment, overalls in proper form, as well as during personal hygiene before and after the start of working hours;
on the way to work or home;
in case of industrial accidents or during the elimination of their consequences.

Industrial injuries are one of the most important problems in modern traumatology, claiming many lives or leading to disability from year to year. The main methods of dealing with industrial injuries are the prevention of their occurrence, the organization of qualified trauma care, as well as professional treatment for employees.

Types of injuries: classification

By the nature of the impact, all types of damage are usually divided into:

Mechanical, arising against the background of a sharp mechanical effect on the tissue. This kind of damage can have varying degrees of severity. Mechanical injuries also include operating, birth and accidental injuries.
Thermal that occurs when tissues are exposed to excessively low or high temperatures. So, these include both burns and frostbite.
Electric, arising from exposure to the body of electric discharges, household or natural.
Chemicals that appear when body tissues come into contact with alkalis, heavy metal salts, acids and other aggressive chemicals. Chemical types of injury can lead to local damage or, absorbed through the skin, poison the body.
Beam, which are the result of prolonged exposure to ionizing radiation. This type of injury does not always have an immediate manifestation, since the protective functions of the body under radiation exposure are not activated immediately.

In addition to the above types of injuries, mental and biological injuries are distinguished. The latter are the result of exposure to the body of microbes, viruses and other pathogens, as well as toxic substances of various origins... Mental trauma occurs against the background of exposure to nerve centers, visual and auditory analyzers of stress factors and stimuli.

By the nature of the impact, all types of possible injuries are usually divided into:

isolated, implying various kinds of damage to one organ or anatomical department;
multiple - similar in parameters damage to various parts of the body, lower and upper limbs or head;
combined, including damage to one or several organs at once, sections of the musculoskeletal system, as well as brain injury;
combined, caused by the action of mechanical, as well as one or several non-mechanical traumatic factors.

According to statistics, one of the most common causes of death and disability, in particular for young people, is head injury. The main risk group is made up of citizens under the age of 50. The incidence of TBI is approximately 300-400 cases per 100,000 people annually. On the territory of Russia, about 400 patients per 100 thousand people are registered annually with a diagnosis of "craniocerebral trauma". At the same time, about 50 thousand people from the above number of patients die or become disabled. The most common causes of TBI in Russia are domestic and industrial accidents, as well as road accidents (road traffic accidents).

This type of injury is damage to the bones of the skull, blood vessels, brain and other intracranial formations. There are other options for TBI:

severe trauma, due to which the bones of the skull retain their integrity, and the intracranial structures are damaged;
violation of the integrity of the skull with minimal brain injury.

Among the main causes of TBI are falls from a height, road accidents, domestic, industrial and sports accidents. The severity of TBI and the individual prognosis for a patient depends on the degree of brain damage.

What is a head injury?

By the type of impact, head injuries are divided into:

acceleration injuries accompanied by diffuse brain damage;
local injuries arising from a blow to the head with an object with a certain force;
compression damage.

Different types of injuries have their own characteristics of occurrence, clinical presentation and prognosis for the patient. Allocate different types TBI:

closed head injuries, including bruises, concussions, compression, as well as damage to the skull, provided that the integrity of the surrounding soft tissues is preserved;
open - injuries in which fractures of the skull bones are accompanied by a violation of the integrity of soft tissues, bleeding of varying intensity or liquorrhea (leakage of cerebrospinal fluid).

It should be noted that open brain injuries are subdivided into penetrating (accompanied by damage to the dura mater) and non-penetrating (respectively, without it).

By the type of damage received, the patient can be diagnosed with:

isolated TBI - trauma not accompanied by other extracranial injuries;
combined craniocerebral injury, in which damage to internal organs and bones of the skeleton is also noted;
combined TBI - damage that occurs against the background of exposure to the body of not only mechanical, but also one or several non-mechanical factors.

Specialists distinguish three stages of TBI in terms of its severity. So, patients can be diagnosed with mild, moderate and severe stages of traumatic brain injury.

Taking into account the form and nature of TBI, the patient's age and state of health, as well as a number of other factors, there are acute, intermediate and long-term periods of its course.

In addition, there are primary and secondary TBI. Primary arises under the influence of mechanical factors that are not caused by any cerebral disorders. The cause of secondary TBI is falls and mechanical blows to the head, for example, in people diagnosed with epilepsy, stroke and a number of other diseases.

Secondary brain injury is the result of a severe head injury. Its frequency is approximately 20% of all patients with this diagnosis. Secondary trauma poses a particular danger to the patient's health and even life. Among the main reasons for this pathology, it is worth noting brain hypoxia, which develops due to the lack of oxygen supply through the respiratory tract, arterial hypotension and a sharp increase in intracranial pressure.

Severe head injury

The consequences of a severe head injury for a patient's health and life depend on the quality and timeliness of the medical care provided. With this type of injury, the victim may have whole line characteristic features, in particular:

repeated vomiting that cannot be overcome;
prolonged loss of consciousness;
confusion and memory loss;
an irresistible desire to sleep and double vision;
cramps and nosebleeds, etc.

The condition of the patient with severe head injury deteriorates rapidly. To provide first aid for a head injury, you must:

lay the patient in a room with dim light, ensuring him complete rest;
put something soft under the head and shoulders, while slightly lifting the victim;
try to stop bleeding from an open wound on the head (while pressing a bandage or a clean cloth to the wound, you cannot press on it if there is a possibility of a fracture of the skull bones).

All these actions must be performed by first calling " ambulance". Before the arrival of doctors, it is important to monitor the consciousness and the presence of breathing in the victim. If there is no breathing, CPR should be started.

The main actions in the diagnosis of TBI include interviewing the victim, taking anamnesis, examining and assessing his condition. If a person has lost consciousness, it is necessary that doctors receive information about the incident from eyewitnesses and workers of the ambulance team that arrived at the scene. When assessing his condition, it is important to make sure of the presence or absence of violations of the integrity of soft tissues and to perform a neurological examination.

One of the most informative instrumental diagnostic methods is CT scan... Using it, specialists can assess the degree of damage to the bones of the skull, brain and other intracranial structures, the presence of pathological processes and the nature of their course. CT can be used for injuries of any severity. Such a study makes it possible to do without a number of previously used diagnostic procedures, in particular, craniography, cerebral angiography, echoencephaloscopy, etc.

If there is no way to immediately conduct a CT scan, magnetic resonance imaging is used for diagnosis. Before an MRI scan, craniography is mandatory to exclude the presence of metallic foreign bodies.

In some cases, echoencephaloscopy is used, which allows the most accurate assessment of the displacement of intracranial structures. When examining children and patients with defects in the bones of the skull, ultrasound can also be used. Less accurate than computed tomography is craniography (X-ray examination without the use of contrast agents). When examining a patient with a head injury, it must be performed in several projections at once. Such a study allows you to identify fractures of the bones of the skull, radiopaque foreign bodies, as well as pneumocephalus.

Eye injury

The main organ of the visual system is quite vulnerable to various injuries. Seemingly minor eye injuries can lead to deterioration or complete loss of vision. The most susceptible to injury are the cornea, vitreous humor or lens. In severe eye injuries, the retina and optic nerve can be damaged. According to statistics, eye damage accounts for 10% of the total number of pathologies of the organ of vision.

Among the main causes of eye injuries are penetrating (accompanied by a violation of the integrity of the membranes of the organ) and non-penetrating wounds, as well as blunt injuries, exposure to high and low temperatures, and various chemicals. According to statistics, in about 90% of cases of damage to the main organ of the visual system are microtrauma and blunt trauma. The total incidence of penetrating injuries is approximately 2%, and approximately 8% of eye injuries are due to thermal burns. Let's take a closer look at the main types of eye trauma:

Penetrating injuries are injuries in which a foreign body can disrupt the integrity of various parts of the main visual organ. Foreign body particles can remain in the eye, causing severe pain and profuse lacrimation, photophobia, and a sharp decrease in visual acuity. With a penetrating wound on the victim's eyeball, you can see the wound itself and the bloody spot around it. Such damage to the eye can lead to destruction of the eyeball and lens, as well as partial or complete blindness.

Non-penetrating injuries are usually the result of bruises and so-called blunt blows. Blunt trauma is the result of damage to the eyeball by various objects. There are three degrees of severity of such an injury. In this case, the trauma of the I degree is mild, the most severe is the III. Such injuries can be characterized by hemorrhage into the eye, retinal detachment, violation of the integrity of the choroid of the organ and retina, as well as the development of traumatic cataracts.

Various parameters are used to classify damage to the main organ of vision. In the field of activity of people susceptible to one or another type of injury, damage can be industrial (received at work), agricultural (possible when performing work and household duties), household (injuries received at home, on the street, etc.) , sports or combat origin. The latter is by far the rarest. The main reasons leading to damage to the main organ of vision include:

small objects, for example, sand, specks, midges, etc.;
various chemicals, in particular household chemicals, building compounds, cosmetics, etc .;
a wide variety of sharp objects, for example, metal shavings in production or when performing household repair work;
blunt blows that occur when, for example, a stone or snowball hits the eye, when hitting with a fist or falling from a height;
thermal effect, which means eye contact with hot liquids, objects, etc.

To avoid negative consequences injuries and preserve a person's eyesight, it is important to provide him with competent assistance on time. So, first aid for eye injuries should be to eliminate the irritating factor, if any.

Treatment of eye injuries

Any damage to the main organ of the visual system requires immediate medical attention. Only a qualified technician using the appropriate equipment will be able to determine the degree of damage and its nature. At the first examination of the victim, the ophthalmologist examines the fundus using a special mirror or ultrasound, assesses the condition of the retina. If the injury is penetrating, radiography is used to assess the patient's condition to determine the presence of a foreign body in the wound. Also, with such injuries, it is important to assess the state of the optic nerve in the affected eye and predict the possibility of preserving vision when using certain tactics of treating the injury.

The choice of tactics for treating injuries should be carried out exclusively by a specialized doctor and may depend on various factors. Its selection is the task of an experienced ophthalmologist. For example, if the integrity of the walls of the eye sockets and eyelids is violated, the victim needs urgent surgical treatment of the injury. The restoration of bone structures and surgical suturing of wounds may also be necessary. If the injury is caused by blows and contusions, anti-inflammatory treatment is required, as well as the use of therapy aimed at resolving hematomas and preventing hemorrhage. First aid for injuries resulting from an impact requires immediate application of cold to the affected area. If the lesions are penetrating wounds and a foreign body remains in the organ, treatment of the injuries requires surgery.

Most of the eye injuries occur due to the entry of foreign bodies of various sizes and types, which can be very diverse. The main first aid for injuries of this type can be provided to the victim, as they say, on the spot. The first thing to do is to prevent the victim from rubbing their eyes, because this can only aggravate the situation. A small foreign body should be removed with a clean piece of cloth (such as a handkerchief). To gently remove an object that irritates and traumatizes the eye, pull down the lower eyelid or try to slightly twist the upper eyelid. If you cannot do this with your own hands, you should immediately contact a specialist.

Spine injury

The causes of spinal injuries can be very diverse. As a rule, various damages are caused by strong mechanical influences as a result of falling from a height, road accidents, impacts, heavy objects falling on a person, etc. Traumatic factors in such situations, for the most part, determine the type of damage received. For example, injuries to the spine of passengers in cars involved in an accident are most often injuries of the cervical spine - the so-called whiplash. The reason for their occurrence is a sharp bending of the neck forward and the same sharp tilting of the head back, which is characteristic of a sudden inhibition of transport. According to statistics, whiplash injuries are much more frequent (approximately 2.5 times) in female representatives of poorly developed cervical muscles. Also, injuries to the cervical spine are often observed in divers who do not adhere to the basic rules of immersion in water. For people injured as a result of a fall from a height, a combined fracture of the spine with damage to the lower thoracic or pelvic region, as well as the calcaneus, is characteristic.

Spinal injuries account for approximately 1% of all types of injuries. These types of injuries include lesions of the spine and spinal cord. Depending on which area is affected, spinal injuries can be:

damage to the vertebrae in various parts of the spinal column
violation of the integrity of the transverse process
damage to the ligaments, which is stretching or tearing
traumatic dislocation
damage to intervertebral discs

There are also uncomplicated and complicated injuries. Uncomplicated are lesions in which there is no violation of the integrity of the spinal cord and its roots.

There are closed and open spinal injuries. The former are more common. With closed lesions, the integrity of the skin and soft tissues that cover the vertebrae is not compromised. Also, stable and, accordingly, unstable traumatic injuries are distinguished. The former include bruises, ruptures of the spinal ligaments, not accompanied by displacement, whiplash injuries (damage to the cervical spine), as well as fractures of the transverse and spinous processes. Unstable injuries mean various injuries that lead to the appearance of pathological mobility of the damaged spine at the time of injury or the progression of pathological deformity in the long term after injury. These specialists include dislocations, spondololisthesis, injuries associated with shifts and sprains, etc.

Depending on the type of injury, their symptoms may differ, as well as the consequences of injuries for patients. So, signs of stable spinal injuries may look like this:

spinal bruises are characterized by diffuse pain in the area of the injury received, swelling and hemorrhage, slight limitation of movement;
distortions are accompanied by sharp pain, pain on palpation and restriction of movement;
fracture of the spinous processes causes sharp pain, and, in addition, the damaged process is often highlighted on palpation;
fractures of the transverse processes, which are more common, are characterized by a number of signs, including Payr's symptom, the so-called symptom of a stuck heel, diffuse pain in the area of the damaged area, etc.;
whiplash injuries of the cervical spine are accompanied by headache, painful sensations in the neck, memory impairment, neuralgia and numbness of the extremities are also possible.

Symptoms of injuries depend not only on the type of injury itself, but also on which part of the spine is affected.

Consequences of spinal injuries

The type of injury, its severity, localization of the affected area are the main factors that determine the prognosis of treatment and the consequences of injury for the patient. According to statistics, severe spinal injuries are the most common and in almost half of cases lead to disability. If spinal column injuries are combined with a violation of the integrity of the spinal cord, their consequences for patients are almost always quite serious and in about 80-95% of cases lead to disability.

The most dangerous are injuries of the cervical spine, combined with damage to the spinal cord. They often lead to respiratory arrest and blockage of blood circulation, which becomes the cause of almost instant death of a person. In addition, with such an injury, the death of the victim is possible as a result of the development of hypostatic pneumonia, urological pathologies and pressure ulcers, leading to blood poisoning.

The most promising in terms of treatment are spinal injuries in children, including injuries sustained during childbirth. This is due to the fact that the child's body is most adaptable to adaptation after various spinal injuries.

What the consequences of injuries will be depends not only on their type, but also on the timeliness and quality of assistance provided to the victim. If help is provided to a person incorrectly, this can only aggravate his condition and make the prognosis of injury treatment less favorable.

Treatment of spinal injuries is a long process and requires complex action. As a rule, its implementation is the task of such specialists as a traumatologist, a rehabilitation therapist and a neurosurgeon.

The causes of leg injuries are manifold. It can be both strong blows and falls, road accidents, excessive physical exertion, etc. These include:

Bruising or crushing injury.

Bruises can cause cracks and even bone fractures, damage to joints. At the site of the bruises, as a rule, a hematoma occurs. The formation of edema is also possible.

Dislocations, which can be congenital (obtained during intrauterine development) or acquired as a result of various leg injuries.

The main symptoms of dislocation are sharp pain, limitation of joint mobility and acceptance of an unnatural position.

A sprain or complete rupture of the ligaments is a leg injury, implying damage to the ligamentous apparatus of the ankle or knee joints, as well as damage to the menisci.

Such injuries occur, as a rule, with excessive stress on the ligaments. At the site of injury, with this type of injury, a hematoma is formed and edema appears, and a sharp, persistent pain is also noted.

Fractures are injuries of the lower extremities that can be open and closed, with or without complications.

The causes of such injuries can be excessive loads on the legs, road accidents, falls, etc. Signs of fractures are pain, rapid formation of edema, hematoma in the area of the affected area, its deformation, a characteristic crunch when moving, limited movement. An open fracture is an injury in which the damaged bone can be seen without special diagnostic methods.

Knee injury

People of all ages are susceptible to various types of knee injuries. Even with normal walking, such damage is possible if certain factors accompany it. For example, natural wear and tear of the knee can increase the likelihood of injury from aging, as well as a number of conditions, such as arthritis or osteoporosis. Most often, an injury to the leg in the knee area occurs in athletes. But people are also often exposed to it during active entertainment (skiing, roller skating, etc.). Industrial and domestic injury is no less likely.

In the human body, the knee joint can be called the largest joint. Between its upper, called the femur, and the lower (greater and fibular) bones, cartilaginous formations, called menisci, are localized. The main legs are connected together by ligaments, tendons and muscles. Inside, the joint is covered by the so-called articular hyaline cartilage, which ensures smooth movement and is an elastic tissue with a smooth surface. Knee injuries most often involve damage to one or more of the above structures.

Acute knee injuries often result from a sudden direct blow to the knee, unnatural bending, twisting of the lower limb, or a fall and knee strike. Such injuries are accompanied by almost instantaneous onset of pain, swelling and bruising. In acute injuries, nerves and blood vessels can be damaged. Sufferers may experience numbness in the injury, coldness, weakness, pallor and blue discoloration at the injury site, and slight tremors in the knee. Among the main types of leg injuries in the knee area are:

damage to ligaments and tendons, in particular their sprain;
rupture of the meniscus;
cracks in the kneecap, more and fibula in the upper part, the femur in its lower part;
dislocation of the patella, most common in girls 13-18 years old;
dislocation of the knee joint is an injury that can occur as a result of a strong blow.

Overuse can also cause knee injury, leading to irritation and inflammation of the knee joint. Such damage occurs due to repetitive actions or prolonged heavy loads. Among the consequences of such influences, it is worth noting:

bursitis, which is an inflammatory lesion of the synovial bags;
tendinitis, which is an inflammatory lesion of the tendons, as well as tendinosis;
Plik's syndrome, which consists in twisting and thickening of the knee ligaments, etc.

Treatments for knee injuries should include prompt provision of medical care, complete rest for the injured limb, professional splint, various physiotherapy procedures, drug treatment and, in some cases, surgery. The choice of treatment method depends on various factors, in particular on the area of the lesion, the type of injury and its severity, the patient's age, state of health and the usual way of life.

Among the main injuries of the hip are fractures and dislocations. The former pose a particular danger to human health and full mobility. Among these types of injuries, there are:

fracture of the upper part of the femur, accompanied by a violation of the integrity of the femoral neck, trochanteric fracture;
fracture of the lower part of the femur;
diaphyseal fracture.

The main risk group for a hip fracture is the elderly. To a greater extent, female representatives are susceptible to such an injury, often suffering from osteoporosis and weak muscle tone. The main cause of an injury to the upper thigh is a fall, a sharp blow, an accident, etc. Elderly people can get this injury from a direct impact or from falling on the hip joint. Also, a fracture of the femoral neck in elderly people can occur with an unsuccessful fall, when a person stumbles and abruptly transfers his body weight to one leg.

Symptoms of a hip fracture are:

Sharp and pronounced pain in the hip joint, radiating to the groin. With an intra-articular fracture, painful sensations may be weak at rest and increase with movement. There is also pain on palpation.
Inverted position of the lower limb. If the hip fracture is accompanied by a displacement, the injured leg appears to be significantly shorter than the healthy leg. With a punctured fracture, this feature is not observed.
The fracture of the upper thigh makes it impossible to raise and straighten the leg while lying down.
If the fracture is trochanteric, the soft tissue around the damaged area swells and bruises.

Separately, it should be said about open fractures, in which a strong one is possible.

With such an injury as a fracture of the femoral neck in it and in the head of the femur, blood circulation is disturbed, which significantly complicates the process of bone tissue fusion. The consequences of such a trauma depend on the location of the fracture. So, the higher its location, the less favorable the prognosis for the patient.

Hip dislocation

Dislocation of the hip is a fairly common injury today. The causes of its occurrence are direct strong impacts, falling from a height, compression as a result of landslides, road accidents, etc. Hip dislocations can be front and back. Posterior dislocation is more common, resulting from sudden rotation or flexion of the hip towards the inside. In this case, the posterior part of the joint capsule is damaged by the head of the femur. Depending on the location of the dislocated articular head, iliac and sciatic dislocation are distinguished.

Anterior dislocation is rare. With such an injury, the head of the femoral bone is displaced downward, as a result of which the articular capsule ruptures. Anterior dislocations are divided into obturator and pubic. Also, such an injury can be congenital, due to defects that have arisen during intrauterine development.

With hip dislocation, there is a visible deformation of the lower limb. In this case, patients experience severe pain. With a posterior dislocation, the limb bends with the knee to the inside and turns out. With strong flexion, there is a high likelihood of sciatic dislocation. Anterior dislocation is accompanied by twisting of the knee outward. With such an injury, flexion of the lower limb in the area of the hip and knee joint is observed, as well as complete limitation of movement.

First aid for trauma, which is a dislocation of the hip, consists in the introduction of anesthetic and immediate hospitalization of the victim. It is important to provide the victim with complete rest and immobilize the injured leg.

When treating an injury of this kind, it is important to correct the joint correctly. This procedure is performed using anesthesia to help the muscles surrounding the damaged joint relax as much as possible. Reduction of dislocations can be done in various ways. The most in demand today are the methods of Depre-Bigelow, Janelidze-Collen and Kefer-Kocher. After the dislocation has been reduced, the patient needs a special retracting splint, which must be worn for about one month. After removing the applied splint, with a favorable course of the applied treatment, the patient is recommended to undergo a special rehabilitation course. Sometimes it may be necessary to use crutches to relieve the stress on the injured leg during movement. Among the complications of hip dislocation, it is worth noting the development of degenerative changes in the damaged joint, called coxarthrosis.