Fracture of the cranial vault
Fractures of the cranial vault of the open and closed type are distinguished, they can be of a fragmentary nature, in the form of cracks or through fractures, with displacement or depression of bone fragments. Typically, people receive such injuries as a result of a domestic or industrial injury, an accident, a street fight, a strong fall or a blow to the head with a heavy object.
Content:
- Pathogenesis of a fracture of the cranial vault
- Symptoms of a fracture of the cranial vault
- Diagnostics of the fracture of the cranial vault
- Cranial vault fracture treatment
- Which doctors should I contact?
Pathogenesis of a fracture of the cranial vault
Such fractures are divided into direct and indirect. The first type is characterized by local damage to the bones at the impact site with the formation of deflections of varying degrees in the inner part of the skull. In this case, the integrity of the inner cranial plate is violated, first of all.
In the case of the second type of fracture, the impact spreads over the entire region of the skull, and the bones under the influence of destructive pressing force are deflected to the outside.
Symptoms of a fracture of the cranial vault
Among the symptoms, signs of a local character are immediately distinguished - this is the formation of a hematoma and an open wound, as well as sagging, which is easily detected by palpation. A person may lose consciousness partially or fall into a coma. In addition, symptoms of impaired respiratory function, paralysis and damage to nerve endings may appear.
After an external examination of the integrity of the bones of the skull and external tissues, the degree of brain damage should be established. For this, an assessment is made of the victim's perception of the surrounding reality and awareness of what happened. The victim may be fully or partially conscious, but not remember the circumstances preceding the injury. This condition is called retrograde amnesia. Also, a person may fall into a coma or a state of stupor. In very severe lesions, there are serious mental impairments and clouding of the mind, in the cardiovascular sphere - a decrease in pulse rate and a slowdown in blood flow (bradycardia).
If the victim was under the influence of alcohol, he must be taken out of the state of intoxication before diagnosing and treating a fracture of the cranial vault. Only then will it be possible to objectively establish the degree of damage and carry out additional examinations by specialists in the field of neurosurgery.
Often for intracranial injuries, subacute isolated hematoma formations are characteristic. The victim has a change of conscious and unconscious states, which alternate for hours or days.
Diagnostics of the fracture of the cranial vault
The diagnosis of a fracture of the cranial vault is clearly confirmed by the presence of depressions, cracks and open wounds. If there are no external signs, then the diagnosis is made based on the size of the hematoma and the nature of the disturbances in the activity of the brain. The final diagnosis is established after X-ray and additional examinations in the hospital.
A thorough and careful study of the cranial vault is required when the victim falls into a coma and with severe disorders of cerebral circulation, in which a person can be conscious for a short time, and then after an hour or two lose it.
After determining local external injuries, they proceed to study the degree of brain injury. Serious damage to the bones of the cranial vault and meninges can lead to irreparable consequences. The pupils of the eyes are checked, their light reaction, width and uniform distance are established. The doctor checks whether there are changes in the bite of the teeth, in the symmetrical position of the tongue and in the muscular activity of the limbs.
For functional disorders of the brain, the development of attacks of bradycardia is characteristic, therefore, doctors constantly monitor the indicators of arterial and intracranial pressure, pulse, and monitor breathing rates.
Cranial vault fracture treatment
What is the first and urgent aid to the victim? With a conscious state of a person and satisfactory external signs, he is placed on a stretcher with his back down, pillows cannot be placed. Head wounds are closed with aseptic dressing.
If the victim is unconscious, it is recommended to be placed on a stretcher on his back half-turned. To prevent a person from rolling forward or backward, the body is covered with a roller made of blankets or clothes. You should carefully monitor the position of the head, it must constantly be turned to the side in order to avoid the ingress of vomit into the trachea and bronchi (if the emetic process begins).
The victim is freed from clothing that can cause additional compression. If you have dentures, glasses, it is advisable to remove them.
Remember! Falling into unconsciousness can be caused by traumatic shock, multiple fractures of the cranial vault, and profuse blood loss. In this case, the victim must be immediately referred and hospitalized in the neurosurgery department.
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Providing medical care in case of respiratory impairment
In such a situation, artificial respiration is urgently used, while the victim's face is covered with a mask. Then drugs for the heart are injected: Cordiamine and Sulfocamphocaine 2 ml each It is forbidden to use narcotic analgesics, which can provoke further disturbance of the respiratory process.
At the onset of vomiting, the oral cavity is cleansed of vomit, then the jaw bones are pushed forward and artificial respiration is applied already with the help of the AED apparatus, also through the surface of the mask. The victim is injected into a vein with glucose 40% solution of 20 ml and Lasix 40 mg.
If an increased motor reflex is observed, sedatives are injected intramuscularly: Diphenhydramine 1% solution of 1 ml (can be replaced with Suprastin 2%). In addition, 2 ml of Cordiamine is additionally injected under the skin.
It is not recommended to wrap up the patient before hospitalization; a cold bladder or an ice heating pad should be placed on the head.
Which doctors should I contact?
The main specialist in the treatment of such pathologies is a neurosurgeon.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
