Treatment of sequelae of craniocerebral injury, treatment principles should be known

The sequelae of craniocerebral injury include coma, headache, abnormal breathing, and in severe cases shock or even brain death. The treatment of craniocerebral injury must ensure that the patient's breathing is smooth, and the patient's psychology must be promptly counseled to eliminate some psychological concerns.

1. Keep the airway open : Patients with acute craniocerebral injury often lose the ability to actively clear secretions due to impaired consciousness. They may have difficulty breathing or even suffocate due to vomitus, blood, or cerebrospinal fluid inhaled into the trachea. Therefore, the secretions from the mouth and nasal cavity should be cleared immediately, the head position should be adjusted to the side or back position, and if necessary, endotracheal intubation or tracheotomy should be performed on the spot to keep the airway open. If breathing stops or ventilation is insufficient, a simple respirator should be connected for assisted breathing.

2. Stop active external bleeding : The scalp has extremely rich blood supply. Simple scalp laceration can sometimes cause fatal external bleeding. Open craniocerebral injury can accumulate large and small arteries of the scalp. Skull fractures can injure the intracranial venous sinuses. At the same time, craniocerebral injuries are often combined with complex injuries in other parts of the body, all of which can cause massive bleeding and lead to hemorrhagic shock, resulting in circulatory failure. Therefore, it is extremely important to stop active external bleeding and maintain circulatory function. On-site first aid treatment includes:

(1) For pulsatile bleeding from visible thicker arteries, the blood vessels can be clamped with hemostatic forceps.

(2) For extensive bleeding from scalp lacerations, a pressure bandage can be used to temporarily reduce bleeding. If conditions do not permit, the entire layer of the scalp can be tightly sutured with thick silk thread, and then removed when further treatment is needed after arriving at the hospital.

(3) Venous sinus bleeding is difficult to treat on-site. If conditions permit, it is best to transfer the patient to the hospital in a head-up or semi-sitting position for further treatment.

(4) For bleeding from open wounds that have exposed brain tissue, gelatin sponge can be applied and then covered with dry gauze. The bandage should not be too tight to avoid aggravating brain tissue damage. [The above (1)~(4) are all added with video materials to show the specific process]

3. Maintain effective circulatory function : Patients with simple craniocerebral injury rarely experience shock. It is often due to combined injuries to other organs, fractures, scalp lacerations, etc. that cause internal or external bleeding, leading to hemorrhagic shock and circulatory failure. However, in case of acute craniocerebral injury, it is not advisable to supplement with large amounts of fluid or saline in order to prevent worsening of cerebral edema. Therefore, timely and effective blood production and rapid blood or plasma transfusion are the most effective ways to prevent shock and avoid circulatory failure.

4. Treatment of local wounds : The principle is to prevent wound re-contamination, infection, and reduce or stop bleeding. After simply clearing foreign matter from the wound, rinse it with saline or cold boiled water, cover it with a sterile dressing, and apply antibiotics and tetanus antitoxin as soon as possible.

5. Prevent and treat brain hernia : When the patient becomes comatose and has unequal pupils, it is a manifestation of severe craniocerebral injury. The side with dilated pupils is usually the side with intracranial hematoma. 250 ml of 20% mannitol should be given intravenously or rapidly intravenously (within 15 to 30 minutes). At the same time, 40 mg of furosemide should be given intravenously and the patient should be transferred immediately. Pay attention to changes in the patient's consciousness and pupils after taking the medicine.