Reasons of ill-timed diagnostics of closed craniocerebral trauma at the damage of person:

1. expressed scray nocifensors;

2. late hospitalization (3-5 day after a trauma);

3. late examination by a neurologist (on 7-10 day after a trauma);

4. state of alcoholic intoxication;

5. not fully collected anamnesis;

6. disorientation of doctor a patient; not set violation of consciousness.

Reasons of death at combined

traumas of person and cerebrum:

1. global destruction of cerebral and facial skull;

2. break of foundation of skull;

3. heavy damages of cerebrum:

а) hemorrhage in the matter of brain;

б) a restriction of brainstem is in the cervical opening;

4. incompatible with life damages of other organs and systems.

At injuries of soft fabrics, simultaneously with the transmission of injuring effort on a cerebrum, the damage of peripheral branches of craniocerebral nerves, squashing of blood vessels, is carried out with formation of large haematomas, irritation areas of person. Injury of soft fabrics of person is combined with the closed craniocerebral trauma of easy degree. But the cases are possible in the barrel of cerebrum.

The plural damages of a few bones of viscerocranium, which combine with the trauma of cerebrum, differ the most heavy and difficult clinical flow. These damages combine more frequent than all with injury of brain of middle or heavy degree, or with the trauma of cerebrum, which is incompatible with life.

Features of diagnostics of combined traumas:

1. clinical symptoms of damage of person and cerebrum;

2. additional methods are sciagraphy of skull, axial-flow computer, NMR, EEG, REOEG, researches of neurolymph and his pressure, laboratory researches;

3. consultations of contiguous specialists (neurologist, neuro-surgeon, LOR, ophthalmologist, traumatologist).

Medical tactic of doctor at the combined traumas to the maxillufacial area

A choice of medical tactic must be to be based on the individual going near every patient. At the same time, there is a list of measures which are obligatory for all of patients regardless of character of damage and type of trauma:

1. Sick with the combined trauma persons and cerebrum subject hospitalization in type medical establishment (separations of neuro-surgery, maxillufacial separations, separations).

2. The condition of treatment is obligatory are observances of the bed mode at the satisfactory state during 1-2 weeks.

3. With the concussion of the head brain a cold is recommended all of patients on a head.

4. For the improvement of exchange processes in nervous fabric 20-30 мл carry out intravenous inflowings 40% solution of glucose.

5. Diagnosticating is obligatory at patient with the damage of cerebrum of гипер- or hypotension syndrome.

At the syndrome the conduct of patients differs excitation, uncritical attitude toward the state, by the not observance of the bed mode. Patients grumble about diffuse head pain. The auditory are marked, visile and haptic: patients do not take away noise, bright light, touch to the bed. Such patient is carry out medullispinal with evacuation of medullispinal liquid and decline of its pressure on 25% in relation to initial (there is 100-200 mm of water post in a norm). Carry out therapy (10 мл 25% solution of sulfate of magnesium of в/м, 1-2 мл 1% solution of Lasixum of в/м). Position of patient in a bed with the semiraised head department.

At hypotension patients are languid, sleepy, mentally emaciated. A person is pale, abundant sweat, head pain increases at the change of position of head. Patients lie without a pillow. 10-15 ml water carry out в/в introduction, tiny introduction under a skin or в/в 300-500 ml 5% solution of glucose. Position of patient in a bed with the raised department of feet.

6. Medicinal treatment which strengthens an organism, milk-vegetable diet, with limitation of salt, rich in vitamins, albumen, limitation of the use of water.

7. Careful and timely treatment of bone wounds, defects of soft fabrics and immobilization of bones for the prophylaxis of festering-inflammatory complications.

8. Necessity of restoration treatment of patients after stationary treatment.