Traumatic brain injury is a mechanical damage of skull and intracranial formations, i.e. brain, blood vessels, cranial nerves, and brain tunic. Traumatic brain injury (TBI) is one of the most urgent problems of modern medicine. Each year, in the United States, more than three million people sustain traumatic brain injury (Silver, McAllister, & Yudofsky, 2011, p. 1). Traumatic injuries of the skull and brain constitute 30-40% of all injuries and occupy the first place in terms of mortality and disability among people of working age. The paper will discuss traumatic injuries and their treatment.
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Therapeutic measures consist in the most complete and rapid recovery of basic vital functions. It is primarily the normalization of blood pressure and blood volume, external breathing parameters and gas exchange. Arterial hypotension, hypoxia, and hypercapnia are secondary damaging factors aggravating the primary traumatic brain injury. Elimination of psychomotor agitation, convulsive, nociceptive and pain reactions optimize pace and full recovery of physiological parameters.
From the moment of the patients admission to hospital, all the necessary set of diagnostic measures is performed, i.e. assessment of neurological status, radiographic studies including computed tomography and cerebral angiography. A realistic assessment of the neurological status reflecting the severity of brain damage can be achieved only after the restoration of life-critical functions. The most important diagnostic method is CT. It, in addition to the identification of intracranial hematomas and contusions, allows visualization of the location, prevalence and severity of edema, and swelling of the brain (Ashley, 2010).
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Depending on the test results, a patient may require either an urgent surgical intervention or the continuation of intensive therapy. If during the first days after the injury, the patients condition is serious or the severity of the condition grows, re-CT is necessary. Since it is possible the formation of delayed intracranial hematomas or increase of bleeding identified in the initial CT scan (Jay, 2000).
Indications for urgent surgical intervention are the presence of factors causing acute compression of the brain or the shift of midline structures of the brain manifested by an increase of cerebral and focal neurological symptoms. It may be epidural, intracerebral or subdural hematoma, acute pneumonia and hydrocephalus, and the presence of dent fracture and penetrating craniocerebral injury. In the absence of indications for surgical intervention and after it, all the patients have intense therapeutic interventions. The main objective of intensive therapy in the traumatic brain injury is the maintenance of disturbed life-critical functions and the basic mechanisms of homeostasis, as well as creation of conditions for the fullest possible recovery of the brain function (Cifu & Caruso, 2010).
Both low and high concentration of glucose in blood can exacerbate the main brain injury, increase swelling, thus, contributing to intracranial hypertension. A large number of scientific facts emphasize the adverse effects of high glucose concentration in blood in the severe traumatic brain injury contributing to the implementation of the following position. The prevention of hyperglycemia reduces the degree of acidosis of the brain and improvement of outcomes parameters (Godoy, 2013).
The frequency of traumatic brain injury and the severity of its consequences give a great social importance to this problem. Therefore, it is very important to diagnose traumatic brain injury and start its treatment.