Injuries of the skull and brain: diagnosis and emergency medical care at the different stages of evacuation

The lecture defines combat injuries of the skull and brain. The frequency of injuries of the skull and brain (soft tissue, penetrating, non-penetrating combined, multiple injuries, isolated and combined, mine-explosive, gunshot), the classification of traumatic brain injury is given. The clinical picture and diagnosis of concussion, slaughter, compression of the brain, diffuse axonal injury are presented. Features of the pathogenesis of combat craniocerebral injuries are shown. Central pathogenetic mechanisms are indicated: violation of the regulatory function of the central nervous system, hypoxemia, endotoxicosis of various genesis. The clinic and diagnosis of combat injuries of the skull and brain are described. Diagnostic criteria are indicated, great attention is paid to: somatic and neurological examination, determination of the severity of the injured person’s condition, active search for all injuries, especially «hidden» injuries without a clear manifestation. The order of examination of the injured was determined. It is indicated that the main indicator of the severity of traumatic brain injury and the criterion of prognosis is the degree of depression of consciousness (according to the Glasgow coma scale), the state of vital functions. The principles of medical care for skull and brain injuries in the conditions of modern warfare are given. Medical care measures at all levels, surgical tactics for gunshot wounds to the skull and brain are presented in detail.