Catad_tema Traumatic brain injury - articles

Traumatic brain injuries: the use of modern nootropic drugs in the acute period and in the treatment of post-traumatic encephalopathy

E.S. Chikina, V.V. Levin,
JSC "Domestic Medicines"

Traumatic brain injury (TBI) is one of the most common types of traumatic pathology, annually it is registered in 2-4 people per 1000 inhabitants. Children and young people predominate among those injured. The socio-economic significance of TBI is great: according to the Ministry of Health of the Russian Federation, in 2003, for every 200 employees, there was 1 case of issuing sick leave an average of 9.6 days. However, the consequences of TBI are most important in social and economic terms, since they can become chronic, worsening the quality of life of the patient, reducing his ability to work and often leading to permanent disability. In 2000, about 70 thousand adults (or 4.7 per 10 thousand of the population) and 17.6 thousand children (6.2 per 10 thousand of the population) were recognized as disabled due to injuries of all localizations, while in the general structure Injury to the share of dysfunction of the central nervous system accounts for up to 30-40%, and in the structure of the causes of disability - 25-30%.

Depending on the damage to the aponeurosis, which prevents the infection from penetrating into the cranial cavity, closed and open TBIs are isolated, and closed TBIs, in turn, are divided into concussion, brain contusion varying degrees severity, diffuse axonal damage, brain compression.

The prognosis for concussion and mild brain injury is usually favorable (provided that the victims follow the recommended regimen and treatment). With a moderate brain injury, it is often possible to achieve a complete restoration of labor and social activity. A number of patients develop asthenia, headaches, vegetovascular dysfunction, disturbances in statics, coordination, and other neurological symptoms.

With severe brain injury, the prognosis is often unfavorable. Mortality reaches 15-30%. Among the survivors, disability is significant, the leading causes of which are mental disorders, epileptic seizures, gross motor and speech disorders. However, with adequate treatment tactics, if there are no aggravating circumstances and complications, after 3-6 weeks there is a regression of intracranial hypertension, meningeal symptoms, as well as focal neurological symptoms.

With compression of the brain, as a rule, urgent surgery; the prognosis, as with diffuse axonal damage to the brain, depends on the nature and degree of damage to the vital structures of the brain.

Thus, in TBI, it is very important to treat patients correctly both in the acute period and to correct the consequences of the injury. One of the leading places in the treatment is occupied by drug therapy aimed at preventing brain hypoxia, improving metabolic processes, restoring active mental activity, and normalizing emotional and vegetative manifestations.

Among the new effective pharmacological nootropic drugs, a special place is occupied by phenotropil, which has a pronounced nootropic, antihypoxic, psychostimulant, antidepressant, vegetostabilizing, anxiolytic, antiasthenic and anticonvulsant effect. The use of phenotropil in patients with TBI has been studied in several clinical trials (Table 1).

Table 1
EFFICACY OF PHENOTROPIL IN PATIENTS WITH TBI

P.P. Kalinsky et al. conducted a comparative study of the dynamics of asthenic and vegetative changes in patients in the acute period of concussion. One group of patients received phenotropil at a dose of 100 mg/day (23 people), the other - standard nootropic therapy (20 people). The course of treatment lasted 1 month, weekly the condition of the patients was assessed using a number of clinical scales. 18 (78%) people from the main group already after 1 day of treatment with Phenotropil at a dose of 100 mg/day subjectively noted a positive effect of the treatment. They pointed to "feelings of a burst of energy", a decrease in daytime sleepiness and general weakness. By the 7th day of therapy with phenotropil, all patients noted a decrease in asthenia and fatigue, at the same time a feeling of cheerfulness and activity appeared, daytime sleepiness disappeared, and the background of mood improved. Minor headache persisted only in 8 (35%) people. By the same period, 11 (55%) people of the 2nd group who received standard treatment had asthenic complaints and moderate vegetative manifestations. By the 14th day of therapy, only 4 (17%) people who took Phenotropil had episodic asthenic complaints. By the same period, asthenic manifestations in the control group remained in 7 (35%) people (Fig. 1).

The most common consequence of TBI is chronic post-traumatic encephalopathy, which is often a dynamic process with a tendency to a progressive course. The leading clinical syndromes of post-traumatic encephalopathy include: 1) neurological deficit syndrome; 2) syndrome of mental dysfunctions (psycho-organic); 3) autonomic dysregulation syndrome (vegetative-dystonic); 4) asthenic (asthenoneurotic) syndrome; 5) syndrome of liquorodynamic disorders; 6) epileptic syndrome. Chronic post-traumatic encephalopathy is mainly characterized by asthenia, diffuse headache ("heavy head"), dizziness, memory loss, sleep disturbance, and focal neurological microsymptoms. At the same time, difficulties in concentrating attention and performing intellectual tasks, emotional lability, polymorphic manifestations of autonomic dystonia, and hypochondria are characteristic. After TBI, post-traumatic dementia is possible, the development of which depends on the nature of TBI and the age of patients (more common in the elderly), as well as depression. According to the results of experimental studies, in patients with post-traumatic depression in the long-term period, the local damaging factor loses its determining value and leading role in the pathogenesis of encephalopathy, nozone-specific cerebral reactions begin to play, one of the manifestations of which is depression. At the same time, the commonality of clinical, neuropsychological and morphological (limbic system) changes in organic (due to closed moderate TBI) and endogenous depressions was confirmed.

At the same time, it is known that TBI contributes both to the faster development of alcohol dependence and the greater malignancy of its course, which further aggravates the clinical picture of post-traumatic encephalopathy. In this regard, the treatment of patients with the consequences of TBI should be comprehensive, affecting all the leading syndromes of post-traumatic encephalopathy.

The effectiveness of phenotropil in the treatment of the consequences of TBI has also been studied in a number of studies.

So, M.M. Odinak et al. studied the effectiveness of phenotropil in the treatment of the consequences of TBI. We examined 48 people aged 19 to 50 years with a head injury of 1 to 10 years. Leading clinical syndromes there were asthenic, psychoorganic, convulsive, liquorodynamic disorders. Patients were 2 groups of 24 people; The 1st group received piracetam 400 mg 2 times a day, the 2nd group received Phenotropil 50 and 100 mg twice a day. Treatment continued for 30 days. The effectiveness of treatment was assessed based on the dynamics of microfocal symptoms, according to subjective feelings, according to neuromapping and transcranial Doppler ultrasound. At the end of the course of treatment, the researchers noted a more pronounced effect of Phenotropil, especially at a dose of 100 mg: improvement occurred already on the 3rd-4th day and was most pronounced in patients with asthenic syndrome. According to a subjective assessment (Fig. 2), best effect Phenotropil. In patients with convulsive syndrome, none of the epileptic seizure, and neuromapping data indicate a positive trend.

S.Yu.Filippova et al. also studied the effectiveness of Phenotropil in patients with long-term consequences of TBI in the form of asthenodepressive, neurotic, hypochondriacal, behavioral disorders, suicidal tendencies. The age of the patients ranged from 37 to 43 years, the duration of TBI - from 7 to 10 years. The patients were divided into 2 groups: the main group (16 people), in which patients received fenotropil at a dose of 100 mg / day for 30 days, and the control group (10 people), who received piracetam at a daily dose of 800 mg, tranquilizers and general tonic ( vitamins). The level of depression and anxiety was assessed on a number of specialized scales, memory and intelligence were studied. Separately, senestopathic, psychopathic, and emotional-volitional disorders were assessed in patients of the main and control groups on a 5-point scale (Fig. 3), in which the minimum score corresponds to the maximum severity of disorders. During the treatment, patients of both groups noted an improvement in memory and attention, however, the dynamics of improvement in memorization abilities was more pronounced in the main group. In patients of both groups, sleep returned to normal, meteolabile manifestations and emotional and volitional disorders decreased. At the same time, anxiety completely regressed in people who received phenotropil, the background of mood increased, suicidal thoughts disappeared, and criticality to their condition appeared.

A.Yu. Savchenko et al. studied the effectiveness of phenotropil in 33 patients aged 40 to 60 years with the consequences of TBI in the form of moderate or severe brain contusion in the frontal or parietal lobes. The duration of the injury ranged from 1 to 3 years. The assessment of neurological symptoms was carried out according to the original scale developed at the Omsk Clinic of Neurology and Neurosurgery, using the MMSE, EuroQol, Hospital Anxiety and Depression Scales.

Significant (p<0,05) изменения в неврологическом статусе: редукция недостаточности III пары черепно-мозговых нервов, снижение выраженности парезов и регресс координаторных нарушений. При оценке MMSE было выявлено достоверное (p<0,05) улучшение ряда показателей когнитивного статуса (табл. 2), уменьшилась выраженность депрессии по Госпитальной шкале тревоги и депрессии: подшкала "Тревога" - 9,7 ± 1,1 балла до лечения и 5,4 ± 0,7 балла - после него (p<0,05); подшкала "Депрессия" - соответственно 10,2 ± 1,0 и 6,2 ± 0,7 балла (p<0,05).

During treatment with phenotropil in patients significantly (p<0,05) улучшилось качество жизни по всем подшкалам EuroQol (табл. 3).

Thus, phenotropil is effective in patients both in the acute period of TBI and in the treatment of its consequences. A distinct effect of the drug occurs after a few days of administration and persists throughout the entire period of treatment. The combination of nootropic and antidepressant action allows a comprehensive approach to the problem of treating patients with TBI, and is also a kind of preventive measure for protracted chronic depression (without classical antidepressants). A characteristic feature of phenotropil, which distinguishes it from other nootropics, is the presence of an anticonvulsant effect, which is confirmed by experimental animal studies. Of course, the clarification of all the mechanisms of anticonvulsant action, the selection of doses for the treatment of epilepsy and the determination of the place of phenotropil in a number of anticonvulsants are the tasks of subsequent clinical studies, but now this feature of the drug allows it to be widely used in patients with TBI, starting from the acute period, without fear of development post-traumatic epilepsy.

Literature:

1. Akhapkina V.I., Voronina T.A. Spectrum of pharmacological effects of phenotropil // Farmateka. - 2005; 13:19-25.
2. Golubchikova O.V., Wasserman L.I., Sergeev V.A. Clinical and psychological phenomenology and symptoms of cerebral deficiency in patients with endomorphic depression. Review of Psychiatry and Medical Psychology. V.M. Bekhterev. - 2004, No. 4.
3. The incidence of the population of Russia in 2003: statistical materials. At 2 o'clock - Part II. - M.: GEOTAR-MED, 2004. - 176 p.
4. Health care in Russia: Stat.sb. / Goskomstat of Russia. - M., 2001. - 356 p.
5. Kalinsky P.P., Solovyov A.P. Experience in the use of phenotropil in the treatment of asthenic syndrome and vegetative disorders of the acute period of closed craniocerebral injury. Report on the approbation of the drug in the Main Clinical Hospital of the Pacific Fleet. - Vladivostok, 2005.
6. Likhterman L.B. Focal contusions of the brain // Medical newspaper. - 2001, No. 20-21. Available at www.medgazeta.rusmedserv.com/2001/20/.
7. Nikiforov A.S., Konovalov A.N., Gusev E.I. Clinical neurology. Textbook. In 3 volumes. T. II. - M.: Medicine, 2002. - 792 p.
8. Odinak M.M., Emelyanov A.Yu., Akhapkina V.I. The use of phenotropil in the treatment of consequences of traumatic brain injury // XI Russian National Congress "Man and Medicine" (April 19-23, 2004). Abstracts of reports. - M., 2004. - S.278.
9. Savchenko A.Yu., Zakharova N.S., Stepanov I.N. Treatment of the consequences of diseases and brain injuries using phenotropil // Zhurn. neurology and psychiatry. S.S.Korsakov. - 2005, 105: 12. - S. 22-26.
10. Savchenko A.Yu. Gliomas of the brain. - Omsk: OmGMU, 1997. - 312 p.
11. Filippova S.Yu., Aleshina N.V., Stepanov V.P. Phenotropil in the treatment of asthenodepressive syndromes with long-term consequences of craniocerebral trauma // Medical Department. - 2005. - V.3, No. 15: - S.158-160.
12. EuroQol Group. EuroQoL: a new facility for the measurement of heath-related quality of life // Health Policy. - 1990; 16:199-208.
13. Folstein M.F., Folstein S.E., McHugh P.R. Mini-Mental State: a practical guide for grading the mental status of patients for the clinician. - Psych. Res. - 1975; 69:167-176.
14. Zigmond A.S., Snaith R.P. The hospital Anxiety and Depression Scale. - Acta Psychiatr. Scand. - 1983. - Vol. 67:361-370.

Phenotropil® - Dossier of the drug

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Semax - instructions for use, analogues and reviews of medicines for the treatment of cerebral dysfunctions and encephalopathies.

News edited by: admin017, 18:57

Reason: clarification of instructions for the drug

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Baklosan - instructions for use, reviews and analogues of the drug for the treatment of multiple sclerosis, cerebral palsy and stroke.

Noopept - instructions for use, reviews and analogues of medication for the treatment of memory and attention disorders, the consequences of brain injury.

Cereton - instructions for use, reviews and analogues of a medicinal product for the treatment of vascular dementia, the consequences of a stroke and head injuries.

Medications for concussion or medical treatment

A concussion is one of the most common consequences of a head injury. Despite the rather calm attitude of many patients to this diagnosis, it can bring a lot of trouble. Therefore, it is extremely important to understand what medications are needed for concussion in adults, and even more so in children, in order to avoid complications in the present and future. But first things first…

How to identify a concussion, symptoms and signs

So, a concussion is a diagnosis that doctors often make with various head injuries, falls and even sharp shakes (for example, small children). The danger lies not so much in a momentary manifestation, but in the presence of unpleasant consequences that can manifest themselves in a few weeks and even months.

It is not difficult to determine the presence of a concussion and this can be done by the totality of symptoms. So, there are three stages of concussion:

A mild concussion is characterized by the following symptoms:

These symptoms disappear within minutes.

Moderate concussion is characterized by:

These symptoms last for minutes.

As for the third stage, its symptoms are similar to those of the second stage, plus loss of consciousness is added to them. As a rule, all other symptoms begin to appear after the victim has regained consciousness.

In addition, the second and third stages are characterized by memory loss. If in the first case for a short period of time, then in the second for a longer one and the parts of the brain responsible for long-term memory can be affected.

First aid

It is important to know how to provide first aid to the victim in order to avoid undesirable consequences.

So, a brief reminder of what to do when providing first aid before the doctors arrive:

1. Reassure the victim if he is conscious.
2. Give his body a horizontal position on a flat surface.
3. Apply a cold compress to your head (ice pack, towel soaked in cold water, or any frozen product). If the incident happened on the street, you can moisten any thing in water and attach it to your head.
4. In the event of a fainting state, the victim must be turned on his side to prevent clogging of the respiratory tract with vomit.
5. With a shallow faint, try to bring the person to his senses (pat on the cheeks, cotton wool with ammonia).
6. The most important thing is that the victim cannot drink water, you can only slightly moisten your lips with a wet cloth.

Medical therapy

Despite the relatively mild nature of this diagnosis and the absence of indications for prescribing medications, in especially severe cases, medical intervention is possible. Such therapy includes the following groups of drugs:

Painkillers

Headaches are one of the most common concomitant symptoms of a concussion. It is for its elimination that painkillers are prescribed, which include:

Analgin

Helps to eliminate headache in case of concussion and is a potent drug. The effectiveness of this drug has been proven by numerous studies.

• first and last trimester of pregnancy;
• kidney and liver diseases;
• asthma;
• low blood pressure.

The maximum dose for an adult is not more than 2000 mg.

The price is from 13 to 63 rubles, depending on the supplier.

Maxigan

An alternative drug to analgin that reduces pain after a concussion.

• kidney or liver disease;
• intestinal obstruction;
• chronic heart failure;
• individual intolerance or sensitivity to the components of this drug;
• the first and last trimester of pregnancy, as well as the period of breastfeeding.

detailed contraindications are indicated in the instructions for use of the drug

The maximum daily dose is 6 tablets or 4 ml of injection (the order of use for children and adults is described directly in the instructions for the drug).

Price from 23 to 423 rubles, depending on the supplier

Sedalgin

This drug is used for moderate or mild pain syndrome and is an analogue of analgin, including in composition.

• children's age up to 12 years;
• individual intolerance to the drug or hypersensitivity to its components;
• insomnia;
• atherosclerosis;
• diseases of the kidneys, liver or blood system.

The price is from 120 to 210 rubles, depending on the supplier.

Pentalgin

An anesthetic with a composition of auxiliary and main components that is different from analgin. It is a good analogue, especially when it is necessary to replace the drug in order to prevent the body from becoming addicted to another drug.

• pregnancy and lactation;
• children's age up to 18 years;
• some diseases of the gastrointestinal tract;
• kidney failure.

a complete list of contraindications is indicated in the instructions for the drug

The duration of admission is not more than 5 days, the maximum daily dose is not more than 4 tablets.

Price from 46 to 160 rubles, depending on the supplier.

Nootropics

This group medicines are the basis for the treatment of head trauma and concussion. The basis of their actions is the normalization of metabolic processes in the brain, which in turn contributes to the normalization of nutrition and blood supply to the brain.

In addition, they help to eliminate the adverse effects of poor blood supply to nerve cells due to hematoma, etc.

The group of neuroprotectors (nootropic drugs) includes:

Piracetam

• breastfeeding period;
• kidney failure;
• hypersensitivity or individual intolerance to the components;
• Use this medicine with caution during pregnancy.

Duration of treatment in children - no more than 3 weeks, in adults - no more than 6 weeks. The maximum daily dose, in a serious condition of the patient, cannot exceed 12 g.

The price is from 31 to 84 rubles, depending on the supplier.

Glycine

• individual intolerance to the components.

The price is from 31 to 90 rubles, depending on the supplier.

Cavinton

• pregnancy and lactation;
• children's age up to 18 years;
• lactose intolerance;
• the presence of arrhythmia;
• individual intolerance to the components of the drug.

The course of treatment cannot exceed three months. The maximum daily dose is 30 mg.

The price is from 170 to 350 rubles, depending on the form of issue and the supplier.

Cinnarizine

1. Pills.

• pregnancy and lactation;
• hypersensitivity to the components of the drug;
• Parkinson's disease.

The dosage is selected by the doctor individually.

The price is from 25 to 40 rubles, depending on the supplier.

Vasotropic agents

In addition to nootropic drugs in the medical treatment of concussion, vasotropic drugs are widely used, which are primarily used to give elasticity to the walls of blood vessels. This property is necessary to counteract pressure from a possible hematoma, and, accordingly, to reduce the risk of vascular rupture.

In addition, vasotropic drugs help to accelerate the transport of oxygen by red blood cells. Blood viscosity normalizes and metabolism in the walls of blood vessels is activated.

It is important that the percentage of the ratio of vasotropic and nootropic drugs should be determined by the doctor, depending on the severity of the concussion, you should not prescribe this or that dosage yourself, this can lead to unpleasant consequences.

Vasotropic drugs include:

Mexidol

• liver and kidney failure:
• individual intolerance to the drug;
• childhood.

The maximum daily dose is 800 mg.

The price is from 231 to 2130 rubles, depending on the form of issue and the supplier.

Oksibral

• pregnancy and lactation;
• childhood;
• individual intolerance to the components;
• acute stroke;
• a brain tumor;
• convulsive conditions;
• violation of the heart rhythm.

The duration of admission depends on the severity of the violations and can be up to one year. The maximum daily dose - no more than 2 capsules.

The price is from 1000 to 1500 rubles, depending on the supplier.

Actovegin

• individual intolerance to the components of the drug;
• pulmonary edema;
• heart failure;
• not removing fluid from the body.

The dosage and method of application is calculated individually by the attending physician.

The price is from 579 to 1544 rubles, depending on the supplier and the form of release of the medicine.

It is extremely unreasonable to take this drug on your own, since even doctors give test injections before using it, since there is a possibility of developing anaphylactic shock.

Diuretics

This group of drugs has several names - dehydrants or diuretics. They are designed to remove excess water from the human body.

The fact is that with head injuries, edema may form in one place or another, which negatively affects general state sick. That's what these drugs are for. Naturally, in the absence of indications, diuretics are not prescribed.

Medicinal diuretics include:

Diakarb

This drug is more likely not a diuretic, but a medicine that helps to remove excess fluid from the body.

• diabetes;
• the first trimester of pregnancy, as well as lactation;
• children's age up to three years;
• kidney or liver failure;
• individual intolerance or hypersensitivity to the components of the drug.

The order of application and dosage is prescribed strictly by the doctor.

The price is from 220 to 300 rubles, depending on the supplier.

Arifon

• hypersensitivity to the components of the drug;
• pregnancy or lactation;
• children's age up to 18 years;
• kidney failure.

The medicine is taken one tablet once a day, strictly under medical supervision.

The price is from 333 to 407 rubles, depending on the supplier.

aldactone

• first trimester of pregnancy and lactation;
• liver and kidney failure;
• diabetes;
• violation of the menstrual cycle;
• breast enlargement.

This drug belongs to the category of strong, so only the doctor calculates the method of application and dosage.

The price is from 3500 to 4500 rubles, depending on the dosage and the supplier.

Sedative drugs

With a concussion, sedatives play an important role, since they are designed to calm the patient and bring his nervous system to a calm state. As a rule, the list of these medicines is quite well known and some of them are available in every medicine cabinet. So, sedative drugs include:

It does not make sense to describe the funds listed, since they are also used without a doctor's prescription (the main thing is wisely).

tranquilizers

And how to treat a victim with signs of a concussion if he is in an extremely severe stage of nervous excitement? In such a situation, sedatives are powerless. The doctor may prescribe stronger sedatives - tranquilizers.

Tranquilizers have a more persistent and faster effect and in most cases cause a healing sleep, remove the feeling of fear and anxiety. However, it should be understood that the use of tranquilizers without supervision and for a long time can cause addiction to the body.

Tranquilizers include:

vitamins

With a concussion, in addition to the above medicines a complex of vitamins and microelements is necessarily prescribed. Listed below are the names of vitamins allowed to be taken:

Any therapy, even vitamin therapy, should take place strictly according to the schedule, which is developed individually by the attending physician.

In addition to vitamins, the doctor may prescribe a drug such as magnesia. This medicine is quite controversial and its effectiveness for a long period raises questions. There is an opinion that it works no more than an hour. However, the doctor prescribes drugs not just at random, but guided by the patient's condition. In addition, there is a certain standard according to which an examination is carried out and a treatment plan is drawn up.

The use of vitamins in the complex is especially important, since, for example, magnesium is much better absorbed into the intestines if the patient takes vitamin B. And magnesium, in turn, affects the functioning of the liver. What fruitfully affects the brain, contributing to its speedy recovery.

The duration of taking vitamins can be longer than outpatient treatment. Usually, the doctor prescribes vitamin support with an eye to home recovery.

Outpatient treatment is an excellent help for a weakened body, however, recovery from a concussion can last up to one year, while hospital treatment takes no more than two weeks. But what about the rest of the time? Undergo a rehabilitation course prescribed by a doctor.

This course includes rehabilitation activities and physiotherapy exercises.

Rehabilitation

Rehabilitation has several goals, and in the first place - the elimination of the likelihood of a concussion recurrence.

• strengthening the body;
• adaptation of the body to physical stress;
• strengthening the vestibular apparatus;
• counteracting the development of serious pathologies against the background of a concussion.

Physiotherapy

Exercise therapy is an integral part of rehabilitation activities. These procedures are prescribed by a doctor and are not independently prescribed. The main thing is not to harm the body affected by the concussion.

As a rule, already on the second day after hospitalization, the patient can begin to perform some light exercises that do not violate bed rest and rest.

Along with physical exercises, the patient must perform breathing exercises.

A month after the injury, the patient can move on to more active physical exercises, using shells, dumbbells, etc.

Gradually, the load should increase so that the body does not get used to it.

Among other things, during the year the patient can be prescribed a special diet and given recommendations to refrain from overwork and oversaturation of the brain with information (limiting the time spent on the Internet and watching TV).

So, drug treatment for concussion is a serious undertaking and should be carried out under the supervision of a specialist. Do not rely on the advice of "experts" on the Internet and self-medicate. Take care of yourself and your loved ones!

Treatment and rehabilitation after traumatic brain injury

One of the most common and severe forms of damage to the nervous system is a traumatic brain injury. Victims often become temporarily disabled or disabled for life. Therefore, in addition to treatment, rehabilitation after a traumatic brain injury is very important.

In complex treatment, each method performs its tasks. The goals of treatment are to eliminate the consequences of trauma, prevention of complications. Recovery tasks include: strengthening the general condition, eliminating muscle weakness, adapting to physical stress.

Treatment of the head after TBI

Before treating cranio- brain injury identify the severity of the patient's condition and tissue damage. There are open and closed injuries of the skull. In turn, open injuries are penetrating and non-penetrating. Closed injuries include bruises and concussions. In each case, patients are prescribed treatment.

In case of concussion, patients are shown rest, bed rest for up to three days. If there are no complications, the patient is observed in an outpatient hospital for up to 6 days. Medical treatment of the head after an injury is reduced to the appointment of painkillers, sedatives and hypnotics, multivitamins, antihistamines.

Patients are injected with a solution of glucose with ascorbic acid, calcium chloride, diphenhydramine. In stressful situations, the patient is prescribed tranquilizers. Even with a mild degree of injury, it is recommended to carry out therapy with vasoactive agents (Cavinton, Nootropil, Actovegin, Gingko Biloba, Cerebrolysin). If more severe brain damage is suspected, spinal function is indicated. In the hospital, the patient is treated for about 2 weeks. Rehabilitation also takes place within 2 weeks. The patient's ability to work is restored in a month.

With a brain contusion, localization of focal lesions is detected using MRI and CT before treatment. Patients are prescribed the same as for concussion. Therapy includes decongestants and drugs that improve blood flow.

If a patient has small focal hemorrhages, the tasks of therapy include:

• elimination of edema;
• improvement of blood circulation;
• increasing the energy supply of the brain;
• improvement of metabolic processes in brain tissues.

Patients are prescribed drugs for traumatic brain injury, which effectively cope with the tasks. Severe bruises with destruction of the brain tissue are treated according to the same principles as bruises of moderate severity, but with the inclusion of intensive care. In a serious condition of the patient, artificial ventilation of the lungs is indicated. If a patient has a brain compression due to an injury, the following therapeutic measures are carried out:

• surgical intervention with increasing compression;
• restoration of airway patency (intubation, ventilation of the lungs on a ventilator);
• prevention of intracranial pressure (Manitol, Lasix);
• anesthesia (Analgin);
• fever control (amidopyrine);
• intensive infusion therapy (intravenously up to 3-4 liters of solutions);
• the appointment of nootropic drugs;
• performing spinal punctures in order to sanitize the cerebrospinal fluid.

In the treatment of brain injury, if the patient is in serious condition, prevention of pneumonia is of great importance. Patients on mechanical ventilation are shown sanitation of the trachea with the use of proteolytic enzymes (Trypsin). Patients are in the hospital until doctors restore acute disorders of the nervous system. In severe cases, patients are given disability.

Patient Recovery Methods

Rehabilitation after a head injury is divided into periods. At an early stage, which lasts up to 5 days, limit all physical activity. Severely ill patients are shown exercises with the help of a masseur or rehabilitologist. The next period lasts about a month. The complex includes breathing exercises, massage and independent movements.

Advice! The main place is occupied by independent exercises to restore muscle endurance and breathing exercises.

During the recovery phase, patients are taught to stand and walk. Patients learn again to correctly distribute body weight on both legs, to move their legs. Rehabilitologists focus on restoring the vestibular apparatus. Patients perform tilts and turns of the head.

In the residual rehabilitation period, patients perform a course of exercises on simulators. To restore everyday skills, occupational therapy and massage are indicated. The goal of rehabilitation measures is to restore blood supply to the paretic muscles.

Thanks to adequate treatment and rehabilitation, recovery after a head injury is much more efficient and faster. Patients with disabilities return to household or work processes, quickly restore personal properties after severe injuries and adapt to new living conditions.

Features of the treatment of TBI, depending on its varieties

Treatment for traumatic brain injury (TBI) ranges from a protective regimen with sedatives to operations on vital brain structures.

concussion

It's a mild head injury. Its therapy is the simplest:

• The main treatment for a concussion is to create a protective regimen.
• In the first few days, it is recommended to reduce fluid intake.
• Depending on the presence and severity of head pain, the patient is prescribed analgesics. As a rule, the use of non-steroidal anti-inflammatory drugs is sufficient. They have anti-inflammatory and, as a result, decongestant and analgesic effect.
• In order to reduce swelling of the medulla and reduce intracranial pressure, diuretics are used, for example, Diacarb.

Brain injury is a very common cause of headaches. Headache with a bruised head is felt in the first minutes or hours after the injury

• The use of sedatives (sedatives) is recommended.
• If necessary, antiemetics are prescribed.
• If there is a history of seizures or when seizure activity is determined on the encephalogram, the use of anticonvulsants prophylactically is recommended.

brain contusion

With a moderate degree of it, the treatment is aimed at restoring the microcirculation of the medulla, the function of the blood-brain barrier, which suffers from a head injury, optimize the metabolism of neurons, and stop the symptoms of inflammation and edema.

Restoration of microcirculation is achieved by thinning the blood, reducing the ability of cells to stick together, and reducing the increased tone of the brain vessels. For this, for example, Cavinton, Trental, Pentoxifylline are prescribed. It is due to the fact that the blood flow in the microcirculatory bed is normalized, sufficient oxygen and energy supply is achieved. The permeability of the vascular wall is normalized. This helps to optimize the water balance inside and outside the vessels, which contributes to the normalization of intracranial pressure.

Correction blood pressure and the elimination of its jumps contribute to the maintenance of normal cerebral blood flow.

If the pain of the head is expressed, then they resort to the use of analgesics, convulsive readiness - anticonvulsants. If there are symptoms of psychomotor agitation, then sedative treatment is used (Sibazon, Thiopental).

Anesthesia for TBI is carried out only with non-narcotic analgesics

Anti-edematous treatment is carried out if symptoms of cerebral compression are determined, with manifestations of increased intracranial pressure, with a rapid deterioration in the condition, if neurological symptoms increase. Diuretics are used: Mannitol, Lasix.

Therapy for severe injuries

Treatment of patients with severe TBI is carried out only in the intensive care unit. However, the initial therapeutic measures begin at the pre-hospital stage.

The severity of the general condition and the level of consciousness of the patient are determined by the Glasgow scale, which takes into account the patient's ability to open his eyes, the degree of speech impairment, and the ability to make movements.

The priority in TBI is to maintain the satisfactory functioning of vital functions - respiration and circulation. It is necessary to ensure the patency of the respiratory tract. First you need to clean them up. If there are symptoms of severe respiratory failure, impaired consciousness by the type of coma, then the patient is transferred to mechanical ventilation. In traumatic shock and low blood pressure, it is maintained with the help of vascular preparations at an optimal level.

If the condition is extremely serious, then it may be necessary to carry out resuscitation measures.

Antibacterial treatment begins no later than 3 hours after the injury. It differs in open head injury and closed craniocerebral injury.

At present, the technique of operations for TBI has been developed quite fully, which makes it possible to carry out complex neurosurgical interventions on various structures of the brain and skull.

Symptomatic treatment consists in the fact that pathological symptoms are stopped. With high blood pressure, it is necessary to lower it to optimal numbers; for tachycardia, drugs that normalize heart rate are used. With hyperthermia, a decrease in temperature is provided by non-steroidal analgesics, putting ice over the head. The question of the need for surgical intervention and the amount of preoperative preparation is immediately resolved.

Intracerebral hematomas

The need for surgical treatment depends on the severity of the injury, damage to the bones of the head, the presence, location, size and dynamics of the hematoma, the features associated with brain damage, and the duration of the injury.

Surgical treatment for hematoma is recommended under certain conditions: its volume exceeds more than 30 ml, there are signs of its increase, compression of the brain structures, their displacement of more than 5-7 mm. Bone trepanation of the bones of the head and the removal of part of the irretrievably damaged brain substance are performed. The scope of the operation is often only accurately determined during the actual surgical intervention. The hematoma is removed. Sometimes a bleeding vessel is determined in its depth. Carry out hemostasis.

Conservative treatment is carried out when the volume of intracerebral hematoma after TBI is not more than 40 ml in the frontal region, 30 ml in the temporal region. If the displacement of brain structures does not exceed 5 mm, focal and cerebral symptoms do not increase.

Naturally, at this time the patient should be in the conditions of the intensive care unit, where the parameters of his condition, changes in hematoma are constantly monitored.

subdural hematoma

It is dangerous due to general compression of the brain by an increasing volume of blood between the dura mater and the arachnoid. Surgical treatment gives better results if it is carried out earlier after the injury. Trepanation of the bones of the head and careful removal of the hematoma are performed, and hemostasis is performed.

The period of increased headaches with subdural hematoma is often accompanied by vomiting.

Conservative treatment is also possible if there is a small amount of hematoma, the displacement of the median structures is not more than 3 mm, neurological symptoms do not increase.

epidural hematoma

It is localized between the inner surface of the skull and the dura mater. Such a pathology is dangerous by the continuation of bleeding, compression of the brain.

Most often there are indications for surgical treatment. This:

• symptoms of brain compression;
• progression of impaired consciousness;
• the diagnosed hematoma volume is more than 30 ml in the localization of the temporal bone and more than 40 ml in another localization;
• hematoma thickness more than 1.5 cm;
• symptoms of displacement of the median formations of the brain more than 5 mm;
• deformation of the ventricles of the brain;
• penetrating brain injury with damage to the bones of the head and brain tissue;
• hematoma of the posterior cranial fossa more than 20 ml, if occlusive hydrocephalus is detected on CT.

The operation consists in trepanation of the bones of the head, removal of the hematoma and creation of hemostasis.

Conservative therapy is permissible with a hematoma volume less than those indicated above, if symptoms of positive dynamics are determined and there are no manifestations of brain dislocation after injuries of more than 5 mm.

Surgical treatment for TBI in the region of the facial skull

In case of cranioorbital craniocerebral injuries, including fractures of the orbits, frontal sinuses, one-stage surgical treatment with the participation of a neurosurgeon, an ophthalmologist, and a maxillofacial surgeon is desirable. Eliminate the focus of injury and pressure, hematoma. Then, the bones of the facial part of the head of various types are reconstructed and repositioned with plates and other metal devices.

The best results are achieved in emergency operations after TBI, when neurosurgical surgical treatment is performed simultaneously with reconstructive manipulation, or with a small difference in time. This is possible with a stable condition of the patient after a traumatic brain injury. Surgery within 72 hours of injury is considered to have good results.

In severe traumatic brain injury, when the patient's condition is severe and unstable, the operation is limited to the removal of cerebral hematomas, the elimination of compression and bone fragments, foci of bruises after injuries.

It is mandatory for all TBI and bed rest to prevent bedsores, postoperative pneumonia.

Activating Therapy

Such treatment is relevant when the patient's consciousness is restored or stable. Contraindicated in the initial, acute period of TBI with labile symptoms, high intracranial pressure.

After the removal of post-traumatic cerebral hematomas, cerebroprotective and metabolic therapy is also carried out, measures are taken to maximize the delivery of oxygen, glucose and other necessary substances to neurons.

Cerebroprotective and metabolic drugs are prescribed: Phenotropil, Riboxin, Sermion, Stugeron, Trental, Ceraxon, Gliatilin, Instenon, Cavinton, Eufillin, Piracetam, Nimodipine, Cerebrolysin, Cinnarizine, Actovegin, Solcoseryl.

Drug treatment usually comes down to drugs that improve metabolism in the brain tissue and vascular drugs.

Ceraxon is especially relevant in the recovery of the brain after a traumatic brain injury. It reduces cerebral edema, pathological permeability of brain cell membranes and vascular walls, prevents the death of brain cells, and reduces neurological manifestations.

Thus, the choice of treatment for head injury depends on many factors. It is only clear that in case of any TBI, the patient should be immediately provided health care.

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concussion pills

Concussion ranks first among skull injuries not only in children, but also in adults. But the danger is the incident itself, and the consequences that revenge may have after a while. To prevent the development of serious diseases after the injury and eliminate the symptoms, concussion pills, which can only be prescribed by a doctor, will help.

Craniocerebral pathology, what is it?

The gray matter does not come into contact with the walls of the skull, thanks to a special protection - cerebrospinal fluid (liquid). As a result of a strong bruise, blow, the brain interacts with the bone tissue and receives a response push from the opposite wall. As a result:

1. The exchange in fabrics is broken.
2. Microcracks are formed in the cerebral cortex, gray matter.
3. Vessels are injured.
4. Nutrients stop flowing to the brain.
5. Possible hemorrhage.

Concussion can be provoked by a fall on a hard surface, injuries received during sports, car accidents. Similar pathologies are diagnosed even in infants, who were rocked with great zeal in a stroller.

Major signs of injury

The pathological state of the brain is accompanied by severe symptoms that appear immediately after the injury, as well as minor ones that make themselves felt after a few hours.

For the first time, depending on the severity of the injury, the patient may experience the following symptoms:

• blurred consciousness lasting 2-3 minutes;
• loss of memory - regarding the events that occurred before the injury;
• spasms that spread throughout the head and create unpleasant discomfort;
• dizziness, unbearable nausea and severe vomiting;
• a flash before the eyes or flickering spots;
• extraneous sounds in the ears;
• disorientation in space;
• fainting from 2-3 minutes, which can last up to 5 hours, depending on the severity of the head injury.

After an hour, the intensity of the symptoms decreases, and relief occurs. It is important to identify pathology in a timely manner in order to start taking pills for concussion, brain disease. Only adequate treatment will prevent the development of late signs: weakness, irritability, insomnia.

First aid for head injury

In case of concussion, that is, the presence of obvious symptoms, the SPM team should be called. Before the arrival of doctors, the victim, if necessary, can be provided with qualified assistance:

1. Lay the patient on a hard surface, only horizontal.
2. Turn your head to one side, this will prevent the swallowing of the tongue, the penetration of emetic fluid into the lungs.
3. If there are no fractures, bend the right leg, put the hand under the head.
4. In case of obvious damage, treat the injured area with an antiseptic, iodine.

First aid is aimed only at alleviating the serious condition of the patient. It is impossible to prescribe medications on your own, only a qualified doctor, after a full examination in a hospital, can tell you which pills are best to drink.

Diagnosis of traumatic brain injury

The first alarm signals after a concussion can remind you of themselves even after a month. Due to a comprehensive examination, including ultrasound, CT, MRI, radiography, and an electroencephalogram, an accurate diagnosis is made.

The severity of a traumatic brain injury is determined based on several factors:

• nature of consciousness;
• vital statistics;
• neurological focal signs.

Changes in the general condition of the patient and his mental, emotional perception of everything around him in the very first days are determined every 2-3 hours.

Patient care

With a mild concussion, after treatment and observation, the doctor sends the patient home in a day. For a quick recovery, the patient is recommended to follow a few rules:

1. Bed rest.
2. The room in which the patient rests should be darkened.
3. From watching TV, tablet and reading will have to give up.
4. You can listen to calm music, but only without using a headset.
5. Eliminate stressful situations.

Medication is indicated only for moderate or severe traumatic brain injury. Therapy is carried out in a hospital under the supervision of a neurologist.

Medications for concussion

The main condition in the treatment of skull injuries is the rejection of the use of aggressive drugs, since the goal of therapy is to restore the working capacity of the gray matter, eliminate headaches, increased irritability, dizziness and other pathological conditions. More often, medications from the group of sedatives, hypnotics and analgesics are prescribed in the form of capsules or intramuscular injections.

Medicines to eliminate pain syndrome are prescribed individually, taking into account the general condition of the patient. The main list of drugs includes:

• medicine "Sedalgin";
• proven drug "Analgin";
• "Pentalgin";
• drug "Maksiganom";
• "Baralgin".

Restore cerebral circulation after a head injury will help tonic preparations and multivitamin complexes - ginseng root or eleutherococcus.

Your doctor may prescribe one of the following medications for dizziness:

1. Bellaspon.
2. medicine "Tanakan".
3. "Betaserk" or "Papaverine".
4. effective medicine "Belloid".
5. "Microzer".

To restore sleep, patients drink Phenobarbital or Reladorm, although some patients limit themselves to taking Dimedrol tablets.

As sedatives are used:

• "Corvalol" (tablets or drops);
• tincture of medicinal valerian or motherwort;
• drops "Valoserdin".

In parallel with the elimination of concussion symptoms, it is recommended to carry out additional measures aimed at treating the metabolic and vascular systems of the body. This will not only accelerate the recovery of gray matter, but also prevent the development of possible post-commotion disorders.

The best options are Cavinton, Nootropil, Sermion, Aminalon or Stugeron.

With increased anxiety, tranquilizers are used:

To eliminate the asthenic condition, the drug "Pantogam", "Cogitum" or one of the multivitamin complexes "Centrum", vitamins "Unicap-T", "Vitrum" can be prescribed. For a general tone, take a tincture of ginseng, lemongrass.

First aid for craniocerebral injuries or suspicions of them - ensuring complete rest, cold lotions and ice compresses. In the absence of severe vomiting, pain medication is indicated.

Recovery after a concussion

Medicines for head injuries should also be taken after discharge from the hospital. To exclude possible consequences, the patient is recommended to adhere to a certain regimen:

• full sleep 8-10 hours;
• constant supply of oxygen;
• optimal air temperature - degrees;
• exclude heavy foods, chocolate, coffee and carbonated drinks;
• do not drink alcoholic beverages;
• stop smoking;
• to maintain muscle tone, light loads are recommended (cycling, swimming, exercise therapy).

After a concussion, the doctor prescribes medication and after treatment in a hospital, as well as physiotherapy - a pressure chamber, manual therapy, massage, acupuncture. The patient needs to give up increased mental and physical stress, protect himself from stressful situations.

Treatment of traumatic brain injury may be carried out at home, but only after a comprehensive examination and consultation with a neurologist. Based on the results obtained, the doctor prescribes appropriate therapy, including taking pills and other effective procedures aimed at restoring the working capacity of the brain, its main functions.

The head is an important part of the whole body and the whole organism, without proper work, which a person will not be able to lead a normal life. Therefore, when the first alarming symptoms appear after a blow, an injury, you should call an ambulance as soon as possible, undergo a full examination and begin proper treatment.

Hitting your head is easy. It does not take a strong blow to cause a concussion. Even in winter it is easy to fall and hit on the ice. I didn't know you could take pills for a concussion. I thought only peace and herbal tea.

There are a lot of concussion pills, but few are really effective and justify the money spent on them. But instead of guessing which pills are better, go to the doctor, get examined normally and agree on a course of treatment with him.

All information on the site is provided for informational purposes only. Before using any recommendations, be sure to consult your doctor. Self-medication can be dangerous for your health.

Sergei Anatolievich Derevshchikov.
659700 Republic of Altai, Gorno-Altaysk. 130 Kommunistichesky Ave., Republican Hospital, Department of Anesthesiology and Resuscitation.
Tel. 2-58-89, E-mail: [email protected]

1. GENERAL PRINCIPLES OF MANAGEMENT OF PATIENTS WITH TBI.

1.1. In case of violation of the functions of vital organs, the examination should be preceded by urgent measures - tracheal intubation, mechanical ventilation, the introduction of vasopressors.

The collection of information should be carried out according to the scheme: Who? Where? When? What happened? For what, after what? What was before?

1.2. Determine the depth of impaired consciousness on the Glasgow scale.

Total 3 - 15 points.

CONSISTENCY of Glasgow performance with traditional methods.

15 - clear consciousness

13 - 14 - stun.

9 - 12 - sopor.

4 - 8 - coma.

3 - brain death.

1.4 Patients diagnosed with TBI should be subjected to dynamic neurological monitoring and instrumental methods of examination.

upon admission to the department.

after 3 hours.

every other day and then daily.

1.4 Scope of examination in case of TBI diagnosis:

Neurological examination (neuropathologist).

X-ray of the chest and skull in two projections.

echoencephaloscopy.

Computed tomography - with an unclear diagnosis.

Lumbar puncture if other methods do not provide sufficient information.

Laboratory examination according to the standard scheme.

Surgeon's consultation.

2. ANESTHETIC MANUAL

USE:

semi-open circuit.

mode of moderate hyperventilation.

sodium thiopental, midazolam, ftorotane up to 1% vol., narcotic analgesics, benzodiazepines.

sodium oxybutyrate in unstable hemodynamics.

DO NOT USE:

Calypsol, ether, nitrous oxide, glucose solutions, dextrans (if there is no shock, hypovolemia).

ATTENTION!

avoid hypotension.

After the end of the intervention, do not transfer the patient to spontaneous breathing until consciousness is restored. Transfer to the intensive care unit to carry out controlled breathing!

3. TREATMENT OF THE ACUTE PERIOD OF TBI (1 PERIOD) GENERAL ACTIONS.

GENERAL EVENTS. Performed as soon as possible. They must be completed within 2 hours of receipt.

3.1 MAINTENANCE OF THE UPPER AIRWAY.

In the presence of signs of aspiration syndrome, impaired consciousness by the type of coma, deep stupor - immediate tracheal intubation.

In the presence of solid particles of food in the aspirated liquid, the progression of acute respiratory failure, an emergency therapeutic and diagnostic bronchoscopy is indicated.

3.2 STABILIZATION OF HEMODYNAMICS.

Strive for a normodynamic or moderately hyperdynamic state of hemodynamics. If the patient has traumatic shock, infusion and other antishock therapy should be carried out in full.

3.3 ARTIFICIAL LUNG VENTILATION.

Indications for IVL in TBI:

Coma (3 - 8 points on the Glasgow scale).

Hyper and hypoventilation syndrome.

Violation of the rhythm of breathing.

The need for medical anesthesia.

With signs of increasing intracranial hypertension.

With concomitant injuries of the chest.

With traumatic shock 2 - 3 tbsp.

With signs of decompensated respiratory failure of any origin.

IN ANY DOUBT IN THE STATE OF THE PATIENT, THE QUESTION IS TO BE DECIDED IN FAVOR OF THE VENTILATOR!

If prolonged mechanical ventilation is expected, nasotracheal intubation is desirable. The endotracheal tube is additionally fixed with adhesive tape.

If the synchronization of the patient with the ventilator is disturbed in the early period, it is advisable to use muscle relaxants.

ATTENTION!

If it is not possible to carry out mechanical ventilation, refuse to administer sedatives and narcotic drugs to the patient.

3.4 BASIC THERAPY IN PATIENTS WITH TBI.

Purpose: to strive to maintain the parameters within the specified limits until the patient recovers from a serious condition.

Give the patient a position with a raised head end (30-40 degrees).

PaO2 > 70 mmHg SpO2 > 92%.

PaCO2 35 - 40 mmHg

BP syst. > 100< 160 мм.рт.ст.

Water balance ±500 ml.

Blood sodium 135 - 145 mmol / l.

Osmolarity 280 - 295 mosm/l.

Hb > 100 g/l. Hematocrit - 30 - 35 percent.

Body temperature< 37,50 С градусов.

Central perfusion pressure > 60 mmHg

Attention!. Do not place the blood pressure cuff on the paresis side of the limb.

3.5 ANTIBACTERIAL THERAPY.

Start no later than three hours from the moment of receipt.

Closed injury - penicillin 2.0 after 4 hours i/v, i/m. or ampicillin 1.0 * 6r / day i.v., i.m.

Penetrating, open TBI, condition after craniotomy, need for mechanical ventilation, aspiration syndrome.

Penicillin 3.0 after 4 hours IV, IM + cephalosporins, preferably third generation (claforan, ceftriaxone).

Consider prophylactic subarachnoid administration antibacterial agents(kanamycin 1 mg/kg or gentamicin 0.1 mg/kg or dioxidine 0.5 mg/kg).

3.6. SYMPTOMATIC TREATMENT.

Used for TBI of varying severity.

With tachycardia; 110 beats per minute - anaprilin (obzidan) 20 - 40 mg * 1 - 4 r / day in a probe or other blockers.

Attention! If the patient is receiving nimotop blockers do not prescribe.

With an increase in body temperature over 37.50 C - non-steroidal analgesics in normal doses (for example, analgin 50% at 2.0 - 4.0 in / in * 3 - 4 r / day). If it is ineffective, the patient is physically cooled (for example, wet wrapping and blowing with air flow, wrapping the limbs with ice bubbles, etc.) against the background of neurovegetative blockade (seduxen, chlorpromazine).

4.1 TREATMENT IN THE ACUTE PERIOD OF SEVERE TBI (first period).

Criteria: 3 - 8 points on the Glasgow scale. The upper and lower parts of the brain, the medulla oblongata are affected.

Clinic: coma, rarely stupor, normothermia or hyperthermia, decrease or increase in blood pressure, heart rate, respiratory rhythm disturbance. Neurodystrophic changes internal organs, skin, asymmetry of blood pressure. The approximate duration of this period is 7 - 14 days.

4.1.1 Sodium thiopental

2 - 4 mg/kg IV bolus. Then 0.5 - 3 mg/kg per hour continuously by doser or bolus. The dose of sodium thiopental should be selected, focusing on the clinic: normalization of body temperature, reduction of tachycardia, normalization of blood pressure, relief of motor excitation, synchronization of the patient with the ventilator. Maintain superficial anesthesia (so that the patient's voluntary moderate motor activity, reaction to painful stimuli, cough reflex is maintained. From day 2, reduce the dose by approximately 50%. On the fourth day, stop the administration of the drug and prescribe long-acting barbiturates, for example, benzonal at 0.2 * 1 - 2r / day.

In unstable hemodynamics, instead of sodium thiopental, ataractics are used (for example, seduxen 10 mg/v 3–5 r/day). If there is a combined injury, then narcotic analgesics are additionally used.

4.1.2 Magnesia therapy.

If there are no contraindications (hypovolemia must be eliminated, blood pressure system. > 100 mm Hg), the introduction should be started from the moment the patient arrives.

Magnesium sulfate: 20 ml of a 25% solution (5 g) is administered intravenously over 15-20 minutes, then intravenous infusion at a rate of 1-2 g/hour for 48 hours. The use of magnesium sulfate is contraindicated if the patient has symptoms of renal failure.

4.1.3 Glucocorticoids.

Attention! - Assign to the most early dates. 8 hours after injury, the following therapy is less effective!

When prescribing, take into account contraindications: the presence of a purulent infection, gunshot wounds, peptic ulcer in exacerbation, etc.

The drug of choice is methylprednisolone sodium succinate. Other glucocorticoid drugs may be less effective.

Methylprednisolone 30mg/kg bolus over 10-15 minutes. Then 5 mg/kg/hour by dispenser or bolus throughout the day. In the next 48 hours - 2.5 mg / kg per hour. Other glucocorticoid drugs - in equivalent doses.

In the absence of a sufficient amount of the drug - use in smaller dosages.

4.1.4 Tirilazad mesylate

(Fridox) 1.5 mg/kg IV cap. every 6 hours for 8 days.

Note: The cost of a course of treatment with this drug is several thousand dollars. If there is no specified drug, then Vit. "E" 30% - 2.0 i / m * 1 r. day for 8 days.

4.1.5 Infusion therapy.

Physical solution 0.9% i.v.

Evenly throughout the day - 2.0 -2.5 liters (30 - 35 ml / kg / day) 2 days. physical solution 0.9% in / in

Evenly throughout the day - 1.5 -2.0 liters (25 - 30 ml / kg / day)

From the end of the second or at the beginning of the third day, the transition to tube feeding with caloric content

1 -1.5 Kcal / day in total up to 1.5 - 2.5 l / day.

In the following days, the caloric content of the diet is gradually brought to the real metabolic needs of the patient.

4.2 TREATMENT IN THE ACUTE PERIOD OF TBI OF INTERMEDIATE Severity (first period).

Criteria: 9 - 12 points on the Glasgow scale. Cerebral hemispheres, extrapyramidal system are affected

Clinical features: stupor, hypokinesia, hypomimia, increased muscle tone of the extremities, cataleptic state, hyperthermia>37<38,5, АД, ЧСС нормальные или умеренно повышены, асимметрия рефлексов.

4.2.1 Sedative therapy.

Attention! Hypovolemia should be absent. Prevent BP drop< 100мм.рт.ст!

The selection of the dose and the frequency of administration of sedative drugs is carried out individually for each patient. Strive for the normalization of blood pressure, heart rate, body temperature, relief of psychomotor agitation, convulsive syndrome.

Long-acting barbiturates, for example, benzonal at 0.2 * 1 - 2r / day. If there are episodes of psychomotor agitation - neuroleptics. Approximate doses: chlorpromazine 12 - 50 mg * 2 - 3r / day. or haloperidol 12 - 25 mg * 2 - 3r / day. in / in or in / m.

4.2.2 Tirilazad mesylate

(Fridox) 1.5 mg/kg IV cap. every 6 hours for 5 days. If there is no specified drug, then Vit. "E" 30% - 2.0 i / m * 1 r. days for 5 - 8 days. (Bruise of the brain, a combination of contusion of the brain and hematoma, condition after surgery for acute hematomas, fracture of the vault and base of the skull in adults).

4.2.3 Fluid therapy

Physical solution 0.9% i.v. Evenly throughout the day - 2.0 -2.5 liters (30 - 35 ml / kg / day) 2 - day and subsequent days.

Liquid and food intake

PER OS in a volume of 1.5 - 2.5 liters with a calorie content of 2 - 3 Kcal / day.

4.3 TREATMENT IN THE ACUTE PERIOD OF SEVERE AND MODERATE TBI UNDER THE CONDITIONS

NON-SPECIALIZED DEPARTMENT (there are no specialists, equipment for ventilation and monitoring, the possibility of intensive treatment).

Therapy is symptomatic. In patients with severe TBI, early tracheostomy is recommended. Do not prescribe narcotic analgesics, and sedatives are used very carefully, in minimal dosages. The patient should not be deeply sedated. Most patients need osmotic diuretics to reduce intracranial pressure from the second to third day (see section 6.1). In treatment, you can use the recommendations given in sections 3.6 and 4.2.

5.SECOND PERIOD (early compensation)

5.1. "ACTIVATIVE THERAPY"

ATTENTION! This therapy should be used when the patient's consciousness is restored or when the patient's level of consciousness is stabilized at the same level.

It is contraindicated in the acute period of head injury, with increased intracranial pressure.

In the period of early compensation, it is indicated in patients with symptoms of "loss" of neurological functions and is contraindicated in patients with symptoms of "irritation"

Assign, usually, from 4 to 5 days in case of TBI of moderate severity, and from 8 to 14 days in patients with severe TBI.

Instenon 2.0 * 3r / day.

Cavinton 20 mg * 3r / day.

Eufillin 2.4% - 10.0 * 3r / day.

Piracetam 20% - 5.0 * 4r / day

Instenon 4mg * 3 r / day.

Nimodipine 30 mcg/kg/hour for 5 days.*

Cerebrolysin 10.0 1 r/day

Cynarizine 0.05 (2t) * 4 r / day

Actovegin, Solcoseryl 10 - 1000 ml 1r / day. in / in cap. (But do not exceed the daily volume of infusion therapy. Joke!).

Most often, intravenous administration is used, but if the patient is conscious, the enteral route of administration is also possible. As a rule, two drugs are prescribed simultaneously with a different mechanism of action depending on the patient's condition (age, blood pressure, etc.). If necessary, change drugs after 7-10 days.

*Note: In the absence of high intracranial pressure, nimodipine can apparently be used in the acute period of TBI.

Careful hemodynamic monitoring should be carried out during its appointment.

With the developed akinetic state

(functional decortication, akinetic mutism), vegetative state, additionally selegelin hydrochloride (Umex) 5 mg * 2 r / day. From the second - third days (from the beginning of the reception), the dose of the drug is increased to 20 mg / day. If there is no effect within 4-5 days, then additionally calypsol (ketalar) 1 mg/kg intramuscularly 1 time per day. If necessary, the introduction of Calipsol is repeated once every three days.

In the absence of selegelin hydrochloride (yumex), levodopa preparations (Nakom, Sinemet, etc.) are used - 1.0 - 4.0 per day, however, the clinical efficacy of this group of drugs is noticeably lower, and the frequency of side effects is higher.

In the presence of symptoms of "irritation"

(convulsive syndrome, vegetative crises) use mainly sedative therapy: benzonal 0.1 - 0.2 * 1 - 2 r / day, chlorpromazine 12 - 50 mg * 3 r / day / m (with psychomotor agitation), relanium 10 mg * 2 - 3 r / day / m. etc. The dose of the drug and their combination must be selected individually.

With motor disorders galantamine 5 - 10 mg 2 r / day in / in, in / m, if not, then prozerin 0.5 - 1 mg in / in, in / m, * 3 r / day. if not, then prozerin 0.5 - 1 mg IV, IM, * 3 r / day.

6. INCREASED INTRACRANIAL PRESSURE. THERAPY.

Manifestations

A. Non-specific signs: headache, nausea, vomiting, increased blood pressure, bradycardia, edema of the nipples of the optic nerves, paresis of the VI cranial nerve, transient visual disturbances and fluctuations in the level of consciousness.

B. The herniation is due to pressure causing displacement of the brain tissue. Manifestations depend on the localization of the pathological process that led to the increase in ICP.

1. Diencephalic herniation occurs when the medial supratentorial localization is damaged and consists in the displacement of the diencephalon through the notch of the cerebellar tenon. This process causes: (1) Cheyne-Stokes respiration; (2) constriction of the pupils with preservation of their reaction to light; (3) upward gaze paralysis; and (4) changes in mental status.

2. The herniation of the medial parts of the temporal lobe occurs when the lateral supratentorial localization is damaged and consists in the displacement of the medial parts of the temporal lobe through the notch of the cerebellar tenon. The resulting pressure on the structures of the midbrain is manifested by: (1) impaired consciousness;

(2) a dilated, non-reactive pupil on the side of herniation, which is associated with compression of the 3rd cranial nerve;

(3) hemiparesis on the opposite side. The movements of the eyeballs are not always disturbed.

3. The herniation of the tonsils of the cerebellum is caused by pressure pushing the lower part of the cerebellum through the foramen magnum, which leads to compression of the medulla oblongata. It causes:

(1) impaired consciousness; and (2) respiratory rhythm disturbances or apnea.

INDICATIONS FOR ANTI-EDEMOTIC THERAPY:

with the development of dislocation syndromes.

on the operating table at the request of the surgeon.

with an increase in intracranial pressure more than 200 mm. rt. Art.

with a rapid (within a few hours) worsening of neurological symptoms.

6.1 Mannitol (mannitol) is administered rapidly (in 15-20 minutes) at the rate of 1 g/kg of body weight. After that enter 3 - 4 times a day at the rate of 0.25 - 0.3 mg/kg.

With insufficient effect or hydrocephalus, Lasix 1 mg / kg is additionally used, if necessary, 2-3 r / day. If the osmolarity is >320 mosm/l, osmodiuretics should not be used.

6.2 If there is no effect from this therapy, the transfer of the patient to mechanical ventilation and the appointment of sodium thiopental are indicated, as indicated in section 4.1. But in this case, the first (loading dose) of sodium thiopental is increased to 8-10 mg/kg.

6.3 CSF drainage through a ventricular catheter is indicated for hydrocephalus. But it is not always feasible, it increases the risk of purulent complications.

6.4 Moderate hypothermia (31 - 330 C), performed for several hours, is quite effective, but requires special equipment and is not yet readily available.

6.5 In the most severe cases: with a rapid deterioration of neurological symptoms (hours and minutes) and the absence of the effect of the therapy by other methods, if it is impossible to use other methods (for example, low systemic blood pressure), hypertonic sodium chloride solution can be used.

Rapid infusion (4-5 minutes) of 7.5% sodium chloride solution is performed at the rate of 4 ml/kg. Then the treatment provided for in paragraph 6.2 (more often) or 6.1 of this section is carried out.

7. PREVENTION AND TREATMENT OF PNEUMONIA.

Sanation-diagnostic fibrobronchoscopy. Mandatory examination of the tracheo - bronchial tree in the first hours after injury. The frequency of bronchoscopy during mechanical ventilation is determined individually, re-appointed with the progression of broncho-obstructive syndrome.

2. Turns in bed every two hours.

3.Toilet oral cavity every six hours.

4. In the presence of purulent discharge from the endotracheal tube, tracheostomy - the introduction of antibiotics, antiseptics into it.

5. The imposition of a tracheostomy is indicated if, a week after intubation, the patient cannot independently and voluntarily cough up sputum. The imposition of a tracheostomy is indicated in the early stages, if the estimated duration of the disturbance of consciousness exceeds 2 weeks.

8. TRAUMATIC MENINGITIS,

Occurs more often on the 2nd and 6th day after the injury. For diagnosis, subarachnoid puncture, bacterioscopy of cerebrospinal fluid is indicated. Treatment to begin immediately after diagnosis!

For traumatic meningitis, if previously untreated:

Penicillin 3.0 * 12 r / day IV + third-generation cephalosporins, such as cefotaxime (Claforan) 2.0 * 6 r / day or ceftriaxone 2.0 * 2 r / day IV + gentamicin 0.2 mg / day kg or kanamycin 2 mg/kg subarachnoid.

If there is no effect from this therapy within two days, consider using one or more of the following drugs: Meronem or Tienam 4–6 g/day, dioxidine 1.0–1.2 g/day, ciproflosacin 1.2–1 .8 g / day. With penicillin-resistant coccal microflora - rifampicin 0.9 - 1.2 g / day or vancomycin 3 - 4 g / in. daily dose all of these drugs are administered intravenously for 3-4 injections.

Amikacin 1 mg/kg or brulamycin 0.2 mg/kg is administered subarachnoidally.

Additionally: metrogil 500 mg * 4 r / day IV - in case of suspected anaerobic infection, in the presence of a brain abscess.

ATTENTION!

do not inject penicillin subarachnoidally (very often develops a severe convulsive syndrome).

carry out subarachnoid punctures daily (with severe meningitis), or every other day (with stable positive dynamics), until the cerebrospinal fluid is sanitized.

9. FEATURES OF MANAGEMENT OF PATIENTS WITH SOME NEUROSURGICAL INTERVENTIONS

after operations associated with craniotomy in case of TBI against the background of preserved consciousness (in patients without signs of severe brain contusion, cerebral hypertension) - depressed fracture, fracture of the vault, epi and subdural hematomas in the early stage of a small volume, etc.

Extubation of the patient should be carried out against the background of fully restored consciousness, usually not earlier than 2 hours after the end of the intervention.

IN postoperative period do not use narcotic analgesics. If necessary (combined injury), it is allowed to use them in reduced doses, organizing continuous monitoring of the patient.

Use 0.9% sodium chloride solution to replenish daily fluid losses.

The patient should be in bed with a raised head end.

Medication is the same as for moderate TBI (section 4).

Traumatic brain injuries, even mild ones, can pose a serious threat to human health. That is why the sooner the patient gets into the hands of an experienced specialist, the more chances for a speedy recovery. The treatment of traumatic brain injury depends on many factors: the severity, age of the patient and the presence of other injuries and diseases.

Principles of therapy

With a brain injury, the speed of first aid is very important. Even a small blow to the head, after which there are no signs of damage: dizziness, nausea, vomiting, loss of coordination, can subsequently lead to serious problems.

Survey

Patients with TBI are necessarily hospitalized in the Department of Neurosurgery, where the doctor performs the initial diagnosis and assessment of the condition. Only after the examination is carried out, an individual algorithm for the treatment and recovery of the patient is built. It is very important to correctly assess the patient's condition and determine the prognosis of the course of the disease, since not only health, but also the life of the patient depends on this.

What examinations are needed:

First aid

Much depends on the speed and quality of first aid. First aid consists of the following:

It is important to know that unconscious patients with open injuries should not be turned over until paramedics arrive - most people with TBI have multiple fractures and spinal injuries. Also, with open injuries, it is impossible to pull out fragments of the skull or foreign objects - only specialists can carry out such manipulations.

The course of TBI involves several periods:

• spicy;
• intermediate (compensatory);
• restorative.

For each period, a specific treatment is selected, which depends on many factors:

Patients with minor injuries, as a rule, stay in the hospital for no more than a day. If nothing threatens their condition, then after receiving appointments they can go home. Patients with moderate injuries are treated in a hospital.

As a rule, the treatment period is at least a month, but if possible, after 2 weeks the patient goes home and is shown to the attending physician once a week. Patients with severe injuries for a long period are in stationary conditions. And even after discharge, they undergo a rehabilitation course to restore speech, motor and other lost functions.

How to help with a brain injury?

Brain contusion is a fairly common injury that occurs during an accident, due to fights, falls or blows to the head. Such damage can be of a different nature: mild, moderate or severe, open or closed, with or without hemorrhage. According to the nature of the injury, the doctor determines how to treat each patient, and individually selects a treatment regimen.

Patients with brain contusion are treated only in stationary conditions, since the consequences of such injuries can cause serious harm to health. Patients with mild and moderate degrees are treated in intensive care units, and patients with severe trauma in the first days are in intensive care under the supervision of specialists.

In most cases, the treatment of a brain injury does not require surgery. First of all, it is necessary to restore such vital functions as breathing and blood circulation. To establish respiratory function and prevent asphyxia and oxygen starvation, oxygen inhalations are carried out. If the patient is not able to breathe on his own, then for this period he is connected to a ventilator.

In 90% of patients with such injuries, there is a decrease in the volume of circulating blood, so its volume is restored by administering drugs with solutions of colloids and crystalloids. Bruising increases intracranial pressure, so the head of the patient's bed should be slightly elevated. To relieve swelling and normalize pressure, diuretic drugs are prescribed, for example: Furosemide or Lasix.

Since brain tissue is damaged during a bruise, drugs are needed that provide nutrition and restoration of brain cells. For this, agents with neuroprotective and antioxidant actions are used:

It is obligatory to take drugs that improve microcirculation: Cavinton, Trental, Sermion, as well as sedatives and vitamins E and group B. With an open brain injury, antibiotics (Cefotaxime, Azithromycin) are necessary to avoid infection and the development of complications, such as sepsis, meningitis and encephalitis.

In rare cases, brain contusion requires neurosurgical care. The operation is performed if cerebral edema increases, intracranial pressure does not decrease, or a large area of ​​crushed brain tissue is observed. The operation is based on trepanation and removal of the damaged area.

Help with Concussion

The most common traumatic brain injury is a concussion. It is very common in both adults and children. Like other injuries, concussion is divided into three degrees, which determines the tactics of treatment.

Mild concussion in adults is a condition that is rarely accompanied by complications. In many cases, no specific treatment is needed other than pain medication, sedatives, and bed rest.

Therefore, after the examination, the patient is sent home under several conditions:

1. Sick leave will be taken.
2. Bed rest is required.
3. You need to see a doctor at least once a week.
4. Take prescribed medications regularly.

IN childhood concussions are observed by specialists within 1-3 days, and if the child's condition does not cause concern, then he is released for outpatient treatment. It is very important for any blow to the head to show the child to the doctors to make sure that nothing threatens his health. A missed concussion can lead to impaired memory, speech, and future learning problems.

The main drugs prescribed for concussion:

1. Painkillers and non-steroidal anti-inflammatory drugs: Analgin, Ibuprofen, Pentalgin, Maxigan.
2. Sedatives: Valerian, Corvalol, Motherwort, Novo-Passit.
3. For sleep disorders: Relaxon, Donormil.
4. With residual neurosis, tranquilizers are prescribed: Afobazol, Phenazepam, Grandaxin, Rudotel.

Less often, concussions are prescribed drugs that promote blood microcirculation (Cavinton, Trental) and drugs with nootropic and neuroprotective effects. Especially often, such funds are prescribed in childhood and old age to help the brain cope with the residual effects after an injury.

What drugs are prescribed:

1. Cerebrolysin.
2. Piracetam.
3. Pantogam.
4. Encephabol.
5. Semax.
6. Cogitum.

If long-term asthenic signs are observed, then complex treatment is necessary, which includes antipsychotics or nootropics, vitamin-mineral complexes, antioxidant drugs and tonics. Elderly patients need to take drugs that improve vascular tone and elasticity, as well as anti-sclerotic treatment that reduces cholesterol deposition on damaged vessels.

Treatment of severe injuries

The most severe TBIs are cerebral compression, diffuse axonal injury, brainstem ruptures, and intracranial hemorrhages. It is with such defeats that the score goes not only for hours and, but also for minutes. The life of the patient and whether he will be able to lead a normal life depends on how quickly treatment is started in the acute period. Many patients with severe TBI remain disabled for life.

The patient's condition depends not only on the nature of the injury, but also on secondary injuries: hypoxia, hypothermia, intracranial pressure, spasms, convulsions, infection. That is why medical measures are aimed at eliminating these symptoms.

Treatment methods in the acute period:

After the acute condition is removed, patients who have suffered severe lesions are prescribed drugs that allow normalizing blood circulation in the vessels of the brain and restoring lost functions. by the most effective drugs Cortexin, Cerebrolysin, Mexidol and Actovegin are considered. These funds not only nourish the brain tissue, but also relieve the effects of hypoxia, restore speech and other cognitive functions.

After discharge, patients who have suffered a severe brain injury undergo a long rehabilitation course, which includes: exercise therapy, electrophoresis, magnetotherapy, acupuncture, massage and other measures to restore lost functions.

home remedies

For traumatic brain injuries, treatment at home should be carried out only after visiting a doctor, and make sure that life and health are not in danger. Principles of treatment at home:

1. At home, you can treat only a concussion and a mild bruise, or undergo recovery after discharge from the hospital.
2. Observe bed rest.
3. Exclude vigorous activity.
4. You can not watch TV, read and use a computer for at least three days.
5. Protect the patient from irritating factors: bright light, noise, unpleasant odors.
6. Exclude heavy foods from the diet, add more fresh vegetables, fruits, cottage cheese and juices.
7. If symptoms of TBI occur or worsen: dizziness, nausea, convulsions, loss of consciousness, you should seek medical help.

Head injuries are not treated folk remedies, but with their help you can eliminate unpleasant consequences, for example: dizziness, weakness, insomnia, lack of appetite. What can be taken:

It should not be forgotten that even mild traumatic brain injuries require a doctor's examination, and after discharge, it is necessary to see a specialist 2 times a year. In childhood, after TBI, the child is shown to a neurologist every 2 months to exclude residual effects.

From the article you will learn about the drugs that are prescribed for concussion, indications and contraindications for the use of drugs, side effects from acceptance.

Symptoms requiring medication

With a concussion, negative symptoms occur, correlated with the degree of damage to the brain structures. Distinguish:

• mild concussion with short-term clouding or loss of consciousness, slurred speech, disorientation in space, pale skin, vertigo, flies before the eyes;
• middle - with fainting up to half an hour, severe headache, double vision, ringing in the ears, loss of orientation in space and time, numbness of the fingers;
• severe - long-term loss of consciousness, amnesia, nausea or vomiting, ataxia up to the inability to stand on their own, vertigo, darkness before the eyes, noise in the head, numbness of the limbs.

List of drugs

In addition to the degree of concussion, when prescribing drugs, the age of the patient is taken into account, physiological features organism, the severity of symptoms. In accordance with clinical picture V complex therapy diseases use drugs of several pharmacological groups.

Painkillers

Pills for concussion of the brain, the main purpose of the appointment are the removal of pain, relief of cephalalgia. The essence is the blocking of pain receptors and the removal of vascular spasm to expand the lumen of the capillaries. The drugs of the group are toxic, so they should not be taken for a long time. Tablets are prescribed only after the diagnosis is made, the pain is not stopped immediately after the injury due to the diagnostic importance of the symptom. Despite the different points of application, all concussion medicines have common characteristics:

• quickly relieve pain;
• eliminate spasm of smooth muscles;
• lower the temperature.

Most often used following pills analgesics or:

Nootropics

Medications for group concussion restore normal neuronal metabolism, normalize nutrition and oxygen supply to the brain, and eliminate post-hematoma symptoms.

Most popular:

Vasodilators

Medicines for concussion of the vasotropes group improve the general condition of patients, normalize the elasticity of the vascular walls, which helps to withstand the high pressure that occurs due to the formed hematoma. Preparations for concussion of this direction vector normalize blood viscosity, which accelerates the delivery of oxygen to the damaged organ, helping regeneration, activating metabolic processes.

The most sought after are:

Diuretics

A concussion of the brain is quite often accompanied by swelling of the tissues, which aggravates the negative symptoms and worsens the general well-being of the patient. Diuretic tablets are designed to remove excess fluid from the body, but are prescribed strictly according to indications.

Pills for dizziness

Vertigo is one of the main symptoms of a concussion. different pharmaceutical groups. But they are allowed to be taken only with persistent dizziness until the intensity of the symptom decreases. Most often recommended the following drugs during concussion, normalizing the patient's condition:

Sedatives

Sedative drugs for concussion are prescribed to relieve psycho-emotional overstrain, sedative, hypnotic effect(the patient is shown a restful sleep for recovery).

More often than others they use: Valocordin (125 rubles), Corvalol (16 rubles), Motherwort (72 rubles). You can drink medicines only with water.

tranquilizers

The purpose of prescribing the pills of the group is similar. However, the drugs are addictive, so the treatment is prescribed in short courses under the supervision of a doctor in a hospital.

Use the following medicines:

vitamins

The complex treatment regimen for concussion must necessarily include vitamin preparations groups A, E, B, C, folic acid and trace elements: phosphorus, magnesium, selenium. These substances provide proper nutrition cells and accelerated tissue repair.

Contraindications

A concussion is treated with a whole range of drugs from different groups, while in the hospital injection therapy prevails, and during the rehabilitation period at home - tablets and capsules. Contraindications to taking pills are individual for each group of drugs, but there are also general restrictions, which include:

• individual intolerance;
• inhibition of bone marrow bleeding;
• IHD: angina pectoris;
• intestinal obstruction;
• glaucoma;
• disruption of the liver and kidneys;
• pregnancy and lactation;
• asthma;
• fluctuations in blood pressure;
• childhood;
• sleep disorders, memory;
• atherosclerosis;
• violation of blood viscosity;
• erosive processes in the intestine;
• lactose-lactase deficiency;
• arrhythmia;
• Parkinson's syndrome;
• brain tumor;
• ONMK;
• convulsions;
• pulmonary edema;
• diabetes;
• mastopathy, breast enlargement;
• violation of menstruation.

Side effects

• allergy;
• dyspepsia;
• vertigo;
• lack of appetite;
• change in taste perception;
• dry mucous membranes;
• acrocyanosis;
• myopathy;
• tremor;
• impaired visual acuity;
• skin rashes;
• apathy;
• blurred consciousness;
• pastosity;
• drug addiction.

An overdose causes symptoms of acute poisoning: nausea, vomiting, chills, convulsions, interruptions in the work of the cardiovascular system.

Chronic drug intoxication manifests itself in painful sensations, violation of trophism (up to gangrene), blood circulation, arrhythmias, sharp jumps in blood pressure. Severe cases are fraught with shock or coma, collapse with a fatal outcome. Therefore, all drugs for any degree of concussion are prescribed by the doctor after a complete examination of the patient, he also makes decisions on further tactics for managing the patient. Self-treatment is dangerous due to the unpredictability of possible complications.