CONTUSION

From Big Medical Encyclopedia

CONTUSION (Latin contusio hurt; synonym general contusion) — the syndrome arising sharply at single-step impact on an extensive body surface of a mechanical injury, sharp pressure difference of the environment and vibration. For designation of a local bruise the term «contusion» is used with the indication of affected body (e.g., a contusion of a brain).

Most often To. develops at defeat by an air shockwave of powerful explosion when the mechanical injury is surely combined with barotrauma (see) and vibrotrauma (see), as well as with acoustic injury (see) though value of the last is small. The terms «explosive injury», «air contusion» often and not without justification apply as synonyms to the term «contusion». However To. arises from action not only an air, but also water shockwave, at underwater explosion, and sometimes without communication with any explosion, as a result of only mechanical influence which is more or less evenly injuring a considerable body surface. So, To. can cause falling in water flatwise from considerable height, blow by the big mass of loose bodies — sand, small stones, napr, at collapses if the victim is keen on a flow of the showered soil. But in these cases from a typical picture K. important components, especially a hearing disorder while at an explosive injury a syndrome To can drop out. develops in full (disorders of consciousness, hearing, the speech, the century of N of page which are shown in various degree) according to weight of defeat.

At the heart of a pathogeny To. ultraboundary braking of c lies. N of page, arising in response to superstrong irritation. Besides, a number of manifestations is caused by changes in the hearing aid, in okolonosovy bosoms; these changes are caused by hl. obr. barotrauma (physical. mechanisms and parameters of the striking action of a shockwave — see. Explosion ).

To the disturbances typical for the general To., quite often join additional, caused by local bruises of fabrics and bodies. At an explosive injury these damages can be divided on primary, caused by the shockwave, secondary, put with stones, logs and other secondary shells, and tertiary, arising at struck, discarded by explosion, at blow about soil, a wall, etc.

From primary damages bruises of a body surface, turned towards explosion are possible; they are shown by bruises, bulging on skin. Heavy, even fatal primary internal injuries are frequent at defeat by a water shockwave and are less probable at air K. Isklyucheniye primary brain injury makes. To a syndrome To. often the frustration caused by primary craniocereberal injury join — contusion of a brain (see), prelum of a brain (see) and concussion of the brain (see). The last, apparently, is observed most often though symptoms of concussion can not always be allocated from an overall picture of a syndrome.

Secondary and tertiary damages vary from lungs (bruises, grazes) to the heaviest, such as rupture of internals, crush of an extremity, spinal fracture, etc. Possibly and a long prelum of big muscle bulks with the subsequent development traumatic toxicosis (see).

The probability of local damages at an explosive injury depends on the power of a shockwave and features of the area, on a cut there was a victim. Secondary and tertiary bruises can reach the largest frequency at To., caused by nuclear explosion in the large settlement. At nuclear explosion there can be combinations To. with thermal and radiation defeats (see. the Combined defeats ).

On intensity a wedge, manifestations three severity K.

Legkaya K. — short-term (several minutes) distinguish stupefaction or only a condition of an oglushennost. Then dizziness, a sonitus, relative deafness, sometimes deafness are observed, difficulty of the speech (stutter), a short disorientation, confusion, moderate vegetative frustration is possible. All phenomena completely disappear in several days.

To. moderately severe — full, but not long (no more than 1 — 2 hour) loss of consciousness, bleeding from ears, sometimes from a nose, a mouth. After recovery of consciousness — dizziness, nausea, vomiting, a headache, deafness, disturbance of the speech from sharply expressed stutter to dumbness is possible; the adynamia and an amimia (mask-like face), are possible twitchings of the head, a tremor of fingers of hands; nek-paradise lability of indicators of a condition of cardiovascular system, moderate perspiration, diffusion, hl. obr. vegetative, nevrol. symptomatology; considerable block, apathy, disorientation. Duration of frustration — up to several weeks.

Heavy To. — loss of consciousness: proceeding of 2 — 3 hours about one days and more, sometimes with disorders of breath and cardiovascular activity, with an involuntary urination and defecation; bleeding from ears, a nose, a mouth. After escaping of unconsciousness — amnesia (see), anterograde or retrograde; severe dizziness with vomiting, painful headaches, a surdomutism, a sharp adynamia, considerable vegetative frustration, especially perspiration; deep block, drowsiness at extremely complicated backfilling; sometimes pristupoobrazno the repeating loss of consciousness, hyperkinesias. It is possible to find changes of an eyeground, and at a spinal puncture — build-up of pressure cerebrospinal liquid (see) and surplus of protein in it. As later manifestations inadequacy of reactions to external irritations, fatigue are observed. Reading, viewing of movies not only cause bystry exhaustion of the patient, but can become impossible — the font blurs, lines are displaced, from flashing of shots there is dizziness, nausea. Emotions accept patol., affective character. Epileptiform attacks are frequent hysterical, sometimes. Similar frustration are possible and later To. moderately severe — at non-systematic treatment, disturbances (especially alcohol intake).

After heavy To., especially followed brain injury with the subsequent cicatricial and atrophic processes, permanent disturbances of mentality (are possible up to weak-mindedness), traumatic epilepsy (see), traumatic parkinsonism (see).

The Slukhorechevy frustration so typical for To., divide into two groups. The hearing disorder connected with barotraumatic changes in peripheral department of an auditory organ — destructive or dislocation enters into the first group. The last (shift of an otolitovy membrane, certain sites of a kortiyev of body) usually do not cause long effects. Ruptures of a tympanic membrane, destruction of formations of a middle and inner ear, hemorrhage in their cavity with the subsequent degenerative atrophy of spiral (kortiyev) body, a spiral node, nerve fibrils conduct (especially at development inf. complications) to long, sometimes to persistent deafness or relative deafness.

The second group includes the disorders of hearing of the central origin caused by disturbance of functions of a brain. At an acoustic injury deafness is caused by braking of the acoustical center under the influence of superstrong sound irritation. On organic character funkts, frustration of c. the N of the page which caused deafness specify in some cases the build-up of pressure and disturbance of circulation of cerebrospinal liquid resulting in asymmetry of side cerebral cavities (according to a contrast encephalography), etc.

A simultaneous hearing disorder and speeches (surdomutism) and furthermore only generally psychogenic origin has speeches (mutism); local injuries of a throat, nose and okolonosovy bosoms lead to change of the speech (an aphonia, hoarseness, twang) that is not characteristic of the general To. In some cases slukhorechevy frustration have mixed (peripheral and central) an origin, and a long surdomutism, as a rule — a hysterical origin.

Alalias without deafness meet seldom and they are short-term; deafness without mutism usually is also not long. At a surdomutism hearing is usually recovered much later, than the speech (in several weeks later To.). For judgment of duration of a hearing loss it is important to differentiate the deafness caused by changes in peripheral department of the acoustic analyzer from the deafness connected with disorder of function of the acoustical centers since at the last there can quickly occur improvement of hearing and even its full return to norm without any effects. After an acoustic injury sometimes there is a lowered perception only of the most high-pitch tones. The uniform bilateral hearing disorder and absence or insignificance of the changes found at an otoskopiya speaks about the central origin of frustration. Explicit asymmetry of acoustical disturbances indicates peripheral damage what there corresponds also the otoskopichesky picture to. Long speech disturbances at quickly recovered hearing speak about a prelum or a bruise of a brain in the field of a motorium of the speech. The general To., not followed by the accompanying local damages, the wedge, manifestations, first of all — disturbances of consciousness is distinguished without difficulties on the basis.

Recognition of an injury of internals is difficult since a picture of the heavy general To. masks symptomatology. From injuries of a brain its prelum an intracranial hematoma, the most demonstrative sign a cut is especially important is secondary (after «a light interval») a loss of consciousness, is frequent with the previous increase of headaches, drowsiness.

Rest is necessary for victims, at To. moderately severe and heavy — a high bed rest on 1 — 3 week. Appoint sedative (bromides) and hypnotic drugs (phenobarbital) of means in a usual dosage, according to indications — the drugs exciting breath and cordial activity. At heavy To., especially with probability of a cherepnomozgovy injury, it is shown spinal puncture (see), it is obligatory with tonometry of cerebrospinal liquid and determination of the content in it of protein and uniform elements. At likvorny hypertensia repeated punctures, dehydrational therapy are necessary, at hypotension — drop injections of 5% of solution of glucose. Upon termination of the acute period appoint redoxons, In 1 , In 12 , antipsychotic drugs (aminazine during 2 — 3 weeks), insulin (4 — 10 PIECES 2 times a day) with reception of glucose inside. Heat baths or souls are recommended. Further at a long postcontusional psychasthenic state the dosed operational load, a periodic sanatorium therapy, observation of the psychoneurologist, full abstention from alcohol are necessary. Treatment of a surdomutism and mutism needs to be begun as soon as possible before at the patient awareness of own inferiority develops. The psychotherapy — the careful systematically repeated research of ENT organs creating visibility of vigorous treatment is of great importance. Treatment of persistent postcontusional deafness of an organic origin — see. Deafness . Resistant alalias demand logopedic treatment.

At accompanying To. injuries of a musculoskeletal system treatment is carried out by the general rules. Emergence or increase of focal symptoms, change of breath testify to a compression of a brain and demand the emergency craniotomy, a cut at an opportunity the angiographic research of a brain shall precede.

Symptoms of band bleeding or irritation of a peritoneum force to laparotomies (see).

Stage treatment

the Volume of the help in the battlefield (in the center of mass defeat) is defined by weight To. Injured, not fainted, at absence == at them wounds, fractures, symptoms of a craniocereberal injury and so forth, in need of evacuation can follow to a post a dignity. transport on foot. Only at visible symptoms of an injury of a pilar part of the head (grazes, hypodermic hematomas) they should be evacuated on a stretcher since it is impossible to exclude possibilities of the damage which is followed by intracraneal hemorrhage and, therefore, the brain threatening with a prelum. Pre-medical medical aid at To. moderately severe and heavy if there are disorders of breath, consists in cleaning of a mouth of clots, sand, etc. In need of an artificial respiration it is necessary to use way of companies in a mouth. At an otorrhagia apply an aseptic bandage an ear, without tamponade. Evacuation is carried out on a stretcher. Existence of changes demands a transport immobilization. Victims with the continuing disturbances of breath, decline of cordial activity, with the bandages and transport tires demanding correction need the help on PMP. The main task of the help in MSB is made by performance of urgent vital operations at accompanying To. heavy local damages.

Treatment struck with To. it is carried out in specialized departments of hospital for wounded in the head, a neck, a backbone.

In the GO first system and the pre-medical help is similarly above described; in OMP — as in MSB. All victims are subject to the direction in BB, irrespective of weight To., in connection with a possibility of late development of displays of not recognizable craniocereberal injury in easily contused. Struck with To. hospitalize in nevrol, hospitals of BB, except for those from whom existence of heavy local damages demands first of all intervention of the traumatologist, the abdominal surgeon and other specialists.



Bibliography: Davidenkov S. N. Postcontusional dysarthtia, Neuropath, and psikhiat., t. 14, No. 1, page 76, 1945; Action of nuclear weapon, the lane with English, under the editorship of P. S. Dmitriyev, M., 1965; 3 yu z and I. K. K N to the analysis of the mechanism of postcontusional states, Neuropath, and psikhiat., t. 15, No. 1, page 26, 1946; Frosts V. N., Maximov G. K. and Neklyudov V. S. Traumatic action of an air shockwave, Voyen. - medical zhurn., No. 2, page 83, 1975; Nifontov B. V. Air explosive injury, M., 1957, bibliogr.; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 4, 8, 26, 29, M., 1950 — 1951; Pathological physiology of extreme states, under the editorship of P. D. Gorizontov and H. N. Si-rotinina, page 107, M., 1973, bibliogr.; Tyomkin Ya. S. Air contusion of an ear, M., 1947.


S. A. Rusanov.

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