Craniocerebral Trauma and Acute Freezing Injuries

Kumanovskiy S.

Municipal City Hospital, Noviy Urengoy, Russia

 

The research goal was improvement of diagnosis and treatment of craniocerebral trauma (CCT), complicated by acute freezing injuries.

Material. There were 54 cases with CCT and acute freezing injuries (supercooling and frostbites), treated in 1998-2004.

Results. A scheme of emergency diagnosis was elaborated. A spectrum of possible complications, typical of different periods of traumatic disease, was determined. An algorithm of differentiated use of heating therapy, allowing to stabilize vital functions and to solve a problem of performing intracranial intervention, was worked out. Severe supercooling is more characteristic of casualties with a gross primary traumatic lesion of the brain. Local freezing injuries are watched more frequently in patients with minor CCT. Moderate and severe supercooling in an early posttraumatic period causes disorders of cardiovascular activity and respiration, gross changes of homeostasis and coagulopathy, which have an unfavorable effect on a course and outcome of CCT. Treatment of mechanic-freezing injuries should be differential with taking into account CCT severity, a degree of supercooling and presence of local freezing lesions. All casualties are subject to passive heating irrespective of a degree of supercooling. It is necessary to use active heating up to 30-32oC in cases with severe supercooling, as it permits to stabilize gross disorders of a cardiac rhythm. Combined mechanic-freezing injuries are characterized by high rates of mortality (20.4%) and disability (33.3%) even in case of a favorable neurological outcome.