Title : Victim of trauma trauma by high caliber firegun: Case report
Abstract:
Background: The main reason for neurological disability and death in young adults is traumatic brain injury (TBI), affecting about 60 million people annually. Recovery is directed by the intensity and severity of the lesion, as well as by the dimension of subsequent damage to inflammatory and neuroendocrine responses, therefore, in the management of patients should minimize the occurrence of secondary reactions.
Objetive: This paper aims to investigate and clarify the consequences of TBI and the possible managements that contribute to a better patient outcome.
Methods: The information contained in the description of the clinical case was obtained through a review of the available medical file and an interview with the patient. To elucidate what was described, data obtained from a collection of scientific articles on TBI were used.
Results: The medical records of a 51-year-old military police sergeant with traumatic brain injury at the Military Police Hospital of the State of São Paulo were obtained. In this document, it is said that the trauma occurred during sector patrols, where he was shot bilaterally in the frontal cranial region with two shots of 7.62mm caliber. The patient was rescued by the fire department vehicle and the Rescue and Emergency Care Group (GRAU) at the scene of the trauma, where he was intubated, sedated and received mechanical ventilation. In the hospital, he was evaluated and taken to the surgical center by the neurosurgery team, where he was submitted to a broad bilateral craniectomy (bilateral fronto-temporo-parietal), superior sagittal sinus closure, hemostasis and duroplasty. The patient evolved to minimally conscious state in the late postoperative period (image 01 and image 02), and was subsequently submitted to cranioplasty with prosthesis made by prototyping with good results (image 03).
Conclusion: The traumatic brain injury caused by firearms is a real and growing possibility in the clinical experience in this scenario of urban violence, being necessary to pay attention to the possible damages caused by the loss of the vascular brain self-regulation.
In this case, it was found that the most aggressive and immediate treatment allowed a recovery of the patient, confirming the findings in the maintain this approach contributes to a reduction in mortality.
Due to the addition of neurodegenerative processes resulting from the expansion of the metabolic activity of neurons stimulated by the death of neurons affected in trauma, leading to a significant increase in free radicals, oxidative stress and neuroinflammatory cascade, one of the events that gains more and more significance in TBI is excitotoxidade.
Despite the patient’s postoperative success, we understand that TBI has social and economic consequences due to post-traumatic stress, such as impairment of executive function, impulsivity, aggressive behavior, depression, among others, it is imperative to stimulate preventive measures. In addition, it is a noble and sensitive organ injury, for this reason, the training of professionals in the trauma and hospital scene is essential for the patient to have a systematic and rapid monitoring and evaluation to avoid this tragic outcome.
What will audience learn from your presentation?
- The main reason for neurological disability and death in young adults is traumatic brain injury (TBI), affecting about 60 million people annually.
- Among the causes that lead to higher mortality rates in penetrating TBI are injuries from firearms.
- The prognosis of these patients depends on the type of projectile, distance from the shot, medical assistance provided at the site of the occurrence and, especially, the place of entry into the projectile. Recovery is directed by the intensity and severity of the lesion, as well as by the dimension of subsequent damage to inflammatory and neuroendocrine responses, therefore, in the management of patients should minimize the occurrence of secondary reactions.
- The traumatic brain injury caused by firearms is a real and growing possibility in the clinical experience in this scenario of urban violence, being necessary to pay attention to the possible damages caused by the loss of the vascular brain self-regulation.
- In situations of homeostasis, the regulation of cerebral vasculature is maintained by mechanisms. However, this is lost in the TBI scenario, and these peripheral blood pressure changes have as consequences cerebral edema, hemorrhagic progression and even evolution to intracranial hypertension.
- It is known that TBI may come from primary or secondary lesions. In primaries, the brain is affected during impact on the skull, leading to bone fractures, neuronal and vascular damage. In secondary lesions, what occurs is a compromise of the blood-brain barrier, neutrophilic invasion and microglial activation.
