Concussion during the Great Patriotic War: what is it?

What is it and what is the ICD 10 code?

According to the 10 microbial code, concussion can manifest itself as a concussion . With a severe concussion, the victim may lose memory for a short time, and remember everything only when the memory returns.

Subtype of severe wound acquired in war

What does it mean to receive this type of serious injury, and in general - is it a wound or not? Undoubtedly, yes! If the temporal or frontal part is bruised, a person may become speechless. Concussion as a serious injury can be a severe concussion with hemorrhage. Sometimes it leads to seizures.

Symptoms of concussion are very similar to a standard concussion , because you can see blood from the ears and nose. It may also be accompanied by fractures, severe bruises, and damage to internal organs.

Severe injury can cause mental disorders such as headache, dizziness, and excessive irritability. The victims need complete rest and emergency hospitalization.

To heal such a wound, you will have to spend a lot of time.

Signs of different degrees

First degree

With first-degree injuries, subarachnoid effusions begin to form.

Loss of consciousness lasts from 30 to 60 minutes. Clinical manifestations are very pronounced - they have a long manifestation and can increase from the second day of injury.

A distinctive feature is a symptom of amnesia. The victim may have trouble remembering why they were injured. This does not appear in all cases. But, since the symptom is transient, relief occurs within a week.

Symptoms of the neurological type after restorative procedures are very distinct - headaches, nausea and vomiting begin. Upon examination, an incomplete reaction to light may be observed. It is also important to examine reflex excitability. Changes in the vegetative-vascular system can be the same as with a concussion.

Second

The anatomical substrate that determines the second degree of contusion is the development of a planar effusion that can occupy the entire field. Loss of consciousness can last from 1 to 4 hours. Symptoms often include breathing disorders and changes in cardiac activity. But, if the treatment is correct, relief will be noticeable within a day.

After the creature is restored, the concussion will manifest itself with dizziness, headache, and lethargy. Amnesia may last a week or several months.

When examining the victim, you can notice that the nasolabial fold is smoothed, peripheral reflexes are asymmetrical, and horizontal nystagmus is observed. However, such symptoms are transient and not long-lasting. Often the process ends with degeneration of the damaged organ.

Third

The anatomical substrate that determines third-degree contusion is extensive hemorrhages around the impact, hemorrhages in the brain tissue or in the ventricles.

In fact, this degree indicates a hemorrhagic stroke.

Signs of third degree concussion: loss of consciousness occurring for more than 4 hours. You can also observe cranial disorders, Babinski and Kernig symptoms.

Diagnosis of injuries along with hematomas inside the brain is carried out in neurosurgical departments. It is important to hospitalize the victim immediately, since only qualified personnel can provide assistance.

Kinds

Contusion can be of the following types:

1. Brain. It occurs due to bruising of the entire body through mechanical action. This could be an impact on the surface of the water or a blast wave. Often, contusion is expressed as a headache, dizziness. You can observe loss of hearing and vision, vomiting and nausea, as well as breathing problems - hyperventilation, loss of coordination, retardation of movements.
2. Eyes. Eye contusion is damage to the eye elements under the influence of the external environment. The cause may be a strong blow from a fall, or a jet of gas or water. Indirect contusion can appear when exposed to different areas. The consequences may be changes in the ocular structure. Blood circulation may be impaired, which will lead to rupture of tissues and blood vessels.
3. Ear. Contusion of this organ leads to hearing loss and even anatomical changes. Damage may occur under the influence of a blast wave. This means a sudden, sharp change in pressure on the eardrum. Often it is destroyed. Hearing can be lost partially or completely.
4. Easy. Closed injury from a blow may be accompanied by subpleural hemorrhages and crushing of lung tissue. With bruises, hemothorax and pneumothorax are rare. With extensive reproduction, wet or shock lung syndrome can be seen. Hemorrhages are caused by merging shadows, the diameter of which ranges from 2 to 4 cm.
5. Guts. Damage to the intestine in peacetime can occur during a transport accident, a fall from a height, or compression between carriages. At the same time, the degree of damage can be different. These can be ruptures of the intestine, their separation from the mesentery. Clinical rupture is determined by the presence of pain in the abdomen.

Degrees

Depending on the severity of the injury, contusion is divided into the following categories:

• Mild degree (first) . In this case, the damage is minor and the symptoms are not too pronounced. This degree of contusion has no negative consequences and does not require special treatment.
• Average degree (second). The patient may lose consciousness for a while. He may experience diarrhea and vomiting. Often there is some lethargy, aggression, problems with heartbeat and breathing. The functioning of the brain is impaired, so all functions slow down.
• Severe degree (third). In this case, the patient may not regain consciousness for up to 3 weeks. Sometimes a patient can die if first aid is not given and taken to the hospital.

Causes

The causes of concussion can be very different:

1. Injured in war by an air blast wave. In the assessment of brain injury over the past 10 years, there have been misconceptions that are associated with traumatic neurosis. But over time, the confusion of defeats and historical manifestations was reduced to nothing. The work of Soviet and Russian doctors played a large role in this. War injuries of this nature are difficult to treat. It is possible that the victim will have to change his activity to a calmer one, try not to visit crowded and noisy places, and also be less nervous.
2. Concussion received as a result of unprotected combat contact. Such damage can occur if a person was close to the site of the shot or explosion. The shock wave affected the brain cells, and such a disease should be treated only under the strict supervision of a doctor.
3. Concussion caused by a fall. Falling from a height can cause very complex injuries and serious damage. It can cause an accident. Regardless of the height from which the fall was made, the body at that moment acquires kinetic energy, which leads to serious consequences. As a result, contusion of the head, ear, intestines and other organs may occur.
4. Other cases. Eye contusion can be caused by a strong blow or a sudden increase in pressure. The reasons for a head injury can be various types of trauma, inflammatory processes in the brain, and disturbances in biochemical parameters. Contusion of the brain and eye can be caused by a sharp change in atmospheric pressure, strong vibrations, a fall from a height, or being blocked by heavy objects.

Expert opinion

Zemlyanukhina Tatyana Vyacheslavovna

Ambulance and emergency paramedic at the Clinical Emergency Hospital #7 in Volgograd.

Ask an expert

The human brain is a rather complex organ and, unfortunately, medicine cannot predict with 100% certainty the consequences of a concussion and the timing, or even the very possibility of reducing its symptoms. The main recommendation in this case is not to withdraw into yourself and follow all the advice of doctors. Also, such a disease is often accompanied by depression, which should also be treated by an appropriate specialist.

What is concussion?

Most often, shell shock in the consciousness and understanding of many people is associated with military activity. However, the opportunity to obtain it in peaceful conditions is no less.

Concussion most often occurs in persons associated with military service

Contusion is an acute injury to both individual organs and all systems, appearing under the influence of a powerful physical and mechanical factor. With this type of injury, there may be no visible violations of the physiological and anatomical integrity of the victim’s body, but serious disturbances in the functional balance occur.

Contusion grossly interferes with basic physiological processes, disrupts the functioning of motor-sensory systems and causes a disorder of higher mental functions. At the same time, suspecting this type of injury is quite problematic.

A possible synonym for the word “contusion” is “bruise.” However, in modern medicine there is no term “contusion of the whole body”, therefore these concepts are identical only when using contusion in the context of local injury (for example, contusion of the auricle). Sometimes in military medicine, to denote pathology, they resort to the concepts of “traumatic stunning” and “injury resulting from the action of a blast wave.”

Mechanisms of injury

The main destructive factor when a contusion occurs is a shock wave, which is vibrations of the airspace of various frequencies and forces that affect the human body. Under their pathogenic influence, a shift in the balance of the human body’s systems occurs, which leads to its physiological restructuring.

Due to a violation of homeostasis (constancy of the internal environment), a change in the level of produced hormones, neurotransmitters, enzymes and biologically active substances occurs. To return everything to its place, the body actively uses its restoration potential, which leads to a breakdown in adaptation mechanisms.

Symptoms of receiving

Signs of concussion depend on its type.

In the brain

When the brain is damaged in the first degree, it sends the following symptoms:

• Headache and nausea.
• Loss of consciousness.
• Dizziness and nausea.
• Amnesia.
• Tachycardia, bradycardia.
• Arterial hypertension.

The average degree manifests itself as follows:

1. Severe amnesia.
2. Prolonged headache.
3. Disruption of the functioning of important organs.
4. Impaired sensitivity.

Symptoms of severe concussion are as follows:

• Loss of creation (about 3 weeks).
• Disturbances in the functioning of internal organs.
• Bradycardia.
• Paralysis of limbs.
• Hearing and speech impairment.
• Profuse hemorrhages.

In the eye

Mild eye contusion manifests itself as follows:

1. Decreased vision clarity.
2. Changes in the eyeball (corneal edema, erosion).
3. Retinal clouding.

Moderate contusion manifests itself as follows:

• Deep corneal erosion.
• Deterioration of vision.
• Local type cataract.
• Presence of hemorrhages.
• Rupture of the ocular sphincter.

The third degree is characterized by:

1. Enlargement of the eye.
2. Damage to the sclera.
3. Hypotension and hypertension.

In the ear

There are first, second and third degrees of ear damage. This occurs due to exposure to sound. If the injury is minor, hearing may be lost for a while. At this point, degeneration of supporting cells and hairs occurs.

If the degree is average, then you can observe injury to the ear canal and organs located next to it. If the degree is severe, then destruction occurs in all cells. In this case, the nerve fibers are affected and hemorrhage appears in the ear canal.

What should you do if someone suffers such damage?

Help for a person who has been shell-shocked must be provided taking into account the fact that he is unconscious. He is completely helpless. Therefore, if, for example, he fell face-first into a puddle, he could easily choke. And if there is a spark on the clothes, it can burn.

If the degree is not severe, then consciousness will return quickly enough , and the only help in this case will be to make sure that he breathes well. It is important to check for bleeding and also call an ambulance quickly. There is nothing more you can do to help.

Now you know what to do first if someone is injured and concussed as a side effect of this disaster.

First aid

To help a person who has suffered a concussion, you need to unfasten clothing that restricts movement, and then lay the victim on his side. The nose and ears are cleared of blood. If the bleeding is prolonged, gauze balls should be placed in the nasal cavity.
It is prohibited to give water or attempt artificial respiration. It is important to take the patient to the hospital as early as possible, and even on a stretcher he is placed on his side.

Treatment

The most important thing during treatment is to provide the patient with peace . He should not hear loud sounds or be in a cramped, stuffy room.

To eliminate hearing loss, it will be necessary to take measures to restore hearing function. In this case, the doctor may resort to restorative therapy. It consists of taking sedative vitamins and medications.

If you have a concussion, you should not listen to music; it is not recommended to watch TV at high volume. The best solution is to avoid places where re-infection is possible.

If any infection occurs, take antibiotics or painkillers. Depending on the patient’s condition, they can calm anxiety and relieve insomnia.

Treatment of pathology

Treatment for mild, severe, and moderate contusions can vary significantly. For uncomplicated pathology, the duration of treatment and recovery is about a week.

When treating a contusion injury of any severity, it is necessary to strictly adhere to bed rest, reduce the negative impact on the affected organ and the complete absence of negative stress factors.

First aid in case of concussion

Any person present at the scene of the incident should be able to provide first aid.

Specialized care is provided by emergency room or hospital doctors.

Algorithm of actions for concussion:

1. Check vital signs: breathing, heartbeat.
2. Determine whether a person is conscious by lightly tapping the face.
3. Call emergency medical assistance.
4. Place the victim in a horizontal position on his back.
5. Turn your head to the side so that the patient does not choke on vomit.
6. If there is vomit, it is recommended to remove it from the mouth using a handkerchief or towel.
7. If there is bleeding from the nose or ears, it is necessary to make tampons from cotton wool or cotton pads to stop the bleeding.
8. If there is a convulsive seizure, you need to gently fix the patient's head and make sure that he does not harm himself or others.

Absolutely forbidden:

• tilt the patient's head back: this can cause vomit to enter the respiratory tract;
• bring the patient to consciousness by hitting or pouring water on the face;
• Perform cardiac massage on a patient with chest injuries;
• try to give the patient a painkiller tablet.

Video: first aid for concussion

Inpatient treatment and medications

After providing first aid in an ambulance, the patient should be sent to a specialized traumatology, resuscitation or intensive care unit. In the first few days after the injury, you must remain in bed. Patients in critical condition are connected to a ventilator.

Medicines used for concussion:

• painkillers: Analgin, Morphine, Methylmorphine and Narcotin will reduce pain and alleviate the condition of the victim;
• non-steroidal anti-inflammatory drugs are prescribed to reduce tissue edema: Ibuprofen, Nimesulide, Ketorolac, Diclofenac;
• glucocorticosteroids will reduce inflammation and relieve spasm: Prednisolone, Methylprednisolone;
• sedatives help restore neuropsychic balance: tincture of valerian and motherwort, camphor;
• antiemetic drugs block impulses from the center of vomiting, reducing the frequency of nausea attacks: Ondasetron, Promethazine, Cyclizine;
• diuretics relieve cerebral edema and stimulate kidney function: Furosemide, Hydrochlorothiazide, Mannitol;
• antidepressants reduce the risk of asthenovegetative syndrome in the future: Fluoxetine, Sertraline.

Photo gallery: drugs used to treat injury

Analgin relieves pain well

Diclofenac will help get rid of inflammation

Furosemide will prevent the development of cerebral edema

In cases of combined damage to the body, as well as in the formation of extensive compression or hematoma of various organs, surgical treatment is used. It is aimed at decompression and reduction of intracranial pressure.

Traditional medicine

Traditional medicine methods can only be used for mild, uncomplicated contusions. Before using any product, you should contact a specialist and consult, taking into account the possible consequences. In no case should you use only traditional methods without drug treatment, since they are aimed only at reducing symptoms and not at eliminating the cause.

Traditional medicine is good for relieving symptoms of concussion

To treat mild contusion, you can prepare the following recipes:

1. 10 tbsp. l. chamomile, pour 1 liter of boiling water and let it brew for two hours. After the resulting liquid has cooled, you need to remove the flowers and drink the infusion one glass twice a day. Chamomile is believed to have a sedative effect.
2. 2 tbsp. l. apple cider vinegar should be dissolved in 0.5 liters of cold water. Then you should moisten a gauze cloth in the resulting vinegar water and place it on your forehead. This method helps cope with migraines.
3. 2 large burdock leaves and 10 currant leaves need to be brewed in 1 liter of hot water. After the liquid has cooled, you should soak cotton wool in it and place it on the sore spot, covering it with a towel on top. Keep it for no more than an hour. Such a compress will help relieve swelling in case of local contusion.

Consequences and precautions

The consequences of such injuries can be determined by the degree of their severity , as well as the structures damaged when following the doctor’s recommendations. Often, complications can appear over time, and this is due to the fact that the brain structure gradually returns to work in a certain order.

Among the consequences the following can be observed:

• Severe headaches.
• Painful reaction to loud noises and lights.
• Sleep disturbances, increased excitability of the nervous system.
• Dizziness.
• Depressive syndrome, manifested by fatigue, apathy, lethargy.
• Stuttering.

If syndromes increase and worsen, it would be a good idea to consult a neurologist or psychotherapist. It may make sense to undergo re-treatment. Some patients are even sent to health resorts to fully recover from injury.

We wrote about the consequences of a cerebral contusion in a separate article.

Possible classifications

Currently, in domestic and foreign traumatology, doctors use several different classifications, each of which reflects certain features of the occurrence of injury and its consequences.

Classification by affected area:

• spinal nerve contusion;
• bone contusion;
• contusion damage to the spinal cord;
• contusion damage to the brain;
• contusion of the organs of hearing and balance;
• contusion of the organs of vision;
• contusion damage to the spinal column;
• contusion damage to the urinary apparatus;
• contusion of the heart and adjacent vessels.

Classification by process extent:

• general contusion;
• local contusion.

General contusion is a uniform damage to all body systems. Local is characterized by the presence of traumatic pathology of one or more organs. Such a contusion is very dangerous and leads to longer treatment complications.

Classification by causes:

• shell shock during military operations;
• concussion due to injuries at work;
• household concussion.

Most often, doctors have to diagnose military personnel with “shell shock”: more than 40% of soldiers had the misfortune to suffer this injury at least once in their lives. In second place in terms of frequency of occurrence is occupational injury among workers at various enterprises. Concussion in everyday life is quite rare.

Classification according to combination with other injuries:

• isolated contusion;
• combined contusion lesion;
• combined contusion.

Classification of concussion severity:

• I degree - mild damage;
• II degree - moderate damage;
• III degree - severe damage.

In the first degree of concussion, a person loses consciousness for no more than 30–40 minutes. In some cases, the stage of absence of consciousness does not occur at all. After the victim wakes up, he is disoriented in space for some time, cannot speak, hear or move normally, and does not remember previous events. Symptoms subside within a few hours.

The second degree is characterized by absence of consciousness for more than two hours. After this, the victim complains of a severe headache, nausea or vomiting, and his pupils may be of different sizes. The duration of cognitive impairment is more than 12–24 hours. Recovery from a moderate concussion takes more than a month.

Severe damage is characterized by complete depression of consciousness up to coma, the duration of which can vary from several days to several months. The patient's reflexes are suppressed, and special life support devices are required to breathe and stimulate the heart. After emerging from a coma, the patient may completely forget some life events and lose self-care skills, speech and some motor functions. The duration of recovery after such an incident can be several years.

Classification according to the presence or absence of complications:

• complicated contusion;
• uncomplicated contusion.

Uncomplicated contusion is the mildest type of traumatic injury and occurs more often in peacetime during everyday interactions. Complicated concussion mainly affects people associated with exposure to some negative factor, as well as the military. This type of pathology is treated only by doctors with special training, and therapy lasts many months.