CONCUSSION (commotio) — the closed bruise of separate bodies and fabrics or all organism which is characterized by disturbance of their functions without rough morphological changes.
Pages are observed at explosion (see) from action of a shock blast air or water wave and during the falling from height; local S. of fabrics meets also at wounds (especially fire) formation at the same time of a zone of a commotio and disturbance in it fiziol. mechanisms (see. Wounds, wounds ). S.'s degree depends at most mechanical impact on fabrics, on the mass of the damaged body, the content in it of water and air, elasticity and elasticity of fabrics, degree of their homogeneity (or heterogeneity).
In a basis pathogeny Pages lie circulatory disturbances in the form of a spasm and the subsequent paretic expansion of small blood vessels with the phenomena staza (see) in them. Under a microscope focal are often visible hemorrhages (see) and ochazhka necrosis (see) in fabrics; even in zones, to-rye usually were considered as zones of disturbance only fiziol. mechanisms, at submicroscopy (see) accurate destructive changes of intracellular organellas, the miliary centers of a necrosis and small hemorrhages are found. At the general S. of an organism these changes meet in serous covers, muscles, joint bags, bones, nervous trunks, kidneys, lungs, heart, etc. The wedge, the picture C. consisting of the general and local symptoms depends on degree and a combination of these changes. The less fabrics are differentiated, the manifestations of Page are less noticeable a wedge. The typical local symptomatology is observed by hl. obr. at S. of a head and spinal cord, bodies of a chest and abdominal cavity. The disturbances caused by S. are short and do not leave behind the expressed and permanent changes.
Wedge, picture the general S. of an organism reminds a picture shock (see) with S.'s signs of separate bodies and fabrics. Decrease in the ABP, tachycardia or a bradyarrhythmia, headaches and dizziness, the general weakness, an adynamia, paresis of extremities (in most cases quickly passing), the neuritis (existing is long) aching an ostealgia and joints, decrease in sight and hearing up to a surdomutism of various duration, a sleep disorder are observed, dysfunction went. - kish. path, delay of an urination, micro and gross hematuria, changes of an ECG (disturbance of conductivity and rhythm, blockade, ischemia of a myocardium). The irritation of a sympathetic and parasympathetic nervous system can cause disturbances of blood circulation, breath, functions of endocrine system, a metabolism owing to what weight of a condition of the victim is aggravated. Heavy S. of an organism can lead to the death of the patient, sometimes instant, from a reflex paralysis of a respiratory and vasomotor center.
At local S. of a brain in mild cases short-term dizziness, pallor, then a hyperemia of the person, perspiration, delay or acceleration of pulse is noted; in more hard cases consciousness is broken (see. Concussion of the brain ).
At local S. of a spinal cord (see. Vertebral and spinal injury ) are observed short-term a paraplegia or parapareses and disturbances of sensitivity.
At local S. of bodies of a chest cavity the thorax is in the provision of a convulsive expiration. The respiratory movements are extremely uneven, are observed sharp asthma (see), quite often cough and pneumorrhagia, general condition of the patient heavy, cyanosis, extremities cold, pulse almost inaudible arrhythmic; consciousness is, as a rule, kept.
At local S. of abdominal organs quite often there are symptoms acute abdomen (see). The page of abdominal organs from action of a blast wave can be followed by hemorrhages in a mesentery and retroperitoneal space, sometimes a rupture of a large intestine (see. Gaps ).
At S. of peripheral nerves sensitive and motive disturbances in the area innervated by the affected nerves on type are noted neuritis (see).
Diagnosis The page is based on the anamnesis (the nature of an injury) and hl. obr. on a wedge, a picture. Sometimes for an exception of heavier internal injuries use additional methods of a research: laparocentesis (see) and a laparoscopy (see. Peritoneoskopiya ), survey X-ray analysis (see), contrast research of digestive organs, intravenous urography (see), the selection angiography (see), ekhoentsefalografiya (see), ultrasonic echolocation (see. Ultrasonic diagnosis ), etc.
Treatment at S. consists in creation of rest and holding the actions directed to elimination of the available disturbances. At the general S. carry out in full antishock treatment (see. Shock ). At S. of a brain apply hypotensive therapy, a kraniotserebralny hypothermia (see. Hypothermia artificial ), etc. At disturbance of breath combat respiratory insufficiency with use of the managed breath (see. Artificial respiration ). Besides, carry out according to indications correction of cardiovascular and endocrine disturbances, and also disturbances of water and electrolytic exchange, vagosympathetic and other types novocainic blockade (see). Are also carried out to lay down. actions for an occasion of the accompanying internal injuries.
Forecast in many respects is defined by S.'s degree of a brain, bodies of a thorax and abdominal cavity.
See also Contusion .
Bibliography: Field surgery, under the editorship of K. M. Lisitsyn and Yu. G. Shaposhnikov, M., 1982; Kaplan A. V. The closed injuries of bones and joints, M., 1979; Lebedev V. V., the Okhotsk V. P. and To and N sh and N. N N. Acute management at the combined traumatic damages, page 82, M., 1980; Fundamentals of traumatology, under the editorship of V. V. Go-rinevskaya, t. 1, page 55, etc., M., 1952; Pies N. I. The beginnings of the general field surgery, p.1, page 193, M. — L., 1941; Frank K. Sports traumatology, the lane with it., page 108, 122, M., 1981; Garlic P. T. and Cold A. Ya. The pathomorphologic shifts in an organism caused by an air shockwave of explosion, Voyen. - medical zhurn., No. 8., page 33, 1970; Sh e r e sh e Sunday to and y G. M. Contusional defeats, in the same place, No. 11 * page 22, 1979.
A. E. Dmitriyev.