Principles of intensive therapy for gunshot wounds of the skull and brain

Abstract

With the modern development of battlefield medicine and air ambulance evacuation, the quality of medical care is undergoing changes. As for neurosurgical combat trauma, the provision of medical care for this patient population requires more specialization, closer to the front line and reduction of stages. The article summarizes the results of experience in the treatment of gunshot wounds to the head. The severity of injuries to the skull and brain on admission was assessed using the Injury Severity Score. The condition of 67% of those admitted was considered severe, the mortality rate was 0.8%, and the length of stay in the intensive care unit was 12 days. Extremely severe were 33% of the wounded, the mortality rate in this group was 2.2%, and the length of stay in the intensive care unit (ICU) was 31 days. When assessing the level of consciousness at our stage on the Glasgow coma scale, most of the wounded had a score of 6–8, which corresponds to a deep coma. Direct evacuation of the wounded to the specialized stage of care, computed tomography (CT), availability of a qualified neurosurgeon, the earliest possible decompressive craniotomy if indicated are the components of success in dealing with intracranial hypertension, the development of subsequent neurological deficit and reducing mortality. Nutritional support and antibiotic therapy are important components of intensive care in neuroresuscitation.