Patient: Patient, male, 17 years old. severe brain injury due to a car accident at 17:00 p.m. on February 18, without seat belt. Admission: temperature 39 degrees, pulse 114/min, blood pressure 154/68, coma, GCS 4, weak spontaneous breathing, transoral tracheal intubation, ventilator ventilation, bilateral pupils 0.4 mm, loss of light reflex, frontal scalp laceration of about 4 cm, which had been cleared and sutured. The dressing oozed blood, swelling was obvious, the left eye had conjunctival hemorrhage, the trachea was centered, the respiratory sounds of both lungs were clear, no dry and wet rales were heard, the heart rate was 114 beats/min, the heart rate was flush, the heart sounds were normal, no obvious pathological murmurs were heard, the abdomen was flat and soft, the liver and spleen were not under the ribs, there were no deformities in the limbs, the muscle tone was enhanced, and the bilateral Bartholin’s sign was positive. Auxiliary examination: CT: extensive brain contusion, brainstem contusion, skull fracture, skull base fracture Blood routine: WBC16.5*10∧9,N89.4%,HB136g/L,PLT226*10∧9 B ultrasound: no effusion seen in the chest and abdomen. Admission diagnosis: heavy craniocerebral trauma, extensive brain contusion, brainstem contusion, skull fracture, skull base fracture, scalp laceration, brain hernia, conjunctival hemorrhage in the left eye. Current examination: confusion, GCS score of 3, bilateral pupils of 0.4 mm, loss of light reflex, subcutaneous bruising and swelling in both eyes, conjunctival hemorrhage in the left eye, and prolapse of the left eye. Autonomic respiration disappeared, heart rate 88 beats/min, body temperature fluctuated at 34.5-36.8 degrees, other than the same as the admission examination. Mannitol 125 q6h, glycerol fructose 500ml q12h, dehydration to lower cranial pressure, fluid, methandiamide, posterior pituitary injection to maintain blood pressure, plasma supplementation of coagulation factors, supplemental albumin; anti-infection, acid control, improve microcirculation and other symptomatic support treatment. It has been 129 hours since the accident (more than 5 days), the brain examination results (basic failure —- doctor’s words), there has been no improvement in voluntary breathing, heart rate, blood pressure, body temperature, etc. normal. CT film by several experts carefully examined, there is no basis for surgical treatment, brain examination results (basic failure —- doctor’s words), there has been no improvement in voluntary breathing, heart rate, blood pressure, body temperature, etc. normal. I’m begging for a cure! Laboratory and examination results: Last seen at: Zhejiang Yuyao People’s Hospital. The second hospital affiliated with Zhejiang University School of Medicine, Department of Neurosurgery Shi key: the situation is written in detail, the current diagnosis is basically no major problems, mainly primary brain injury is more serious, how to prevent and treat secondary brain injury is related to the final prognosis of this patient. The following comments are made for reference: 1. The patient has high muscle tone, “bilateral pupils 0.4mm”, is it determined? The positive pathological signs indicate that brainstem injury does exist and is responsible for the poor recovery of spontaneous breathing. Magnetic resonance examination if necessary to clarify the imaging changes of brainstem injury. Drugs to improve cerebral blood supply, prevent cerebral vasospasm, and ice caps to reduce cerebral metabolism are important. 2. Prevent pulmonary complications with turning, back patting, nebulization, and sputum aspiration. Patients who have coughing reflex under stimulation should still be tracheotomized and ventilator-assisted breathing as early as possible, which can facilitate aspiration and prevent collapsed pneumonia and pulmonary atelectasis; secondly, it can stimulate respiratory muscle excitation and improve spontaneous breathing. 3. Blood gas analysis at least once a day to correct acid-base electrolyte balance. 4, on the use of ventilators, early ventilator-assisted breathing in patients with extra-severe traumatic brain injury is critical to ensure brain oxygenation and create conditions for surgery and other treatments. However, mechanical damage to the alveoli and pneumonia brought about by the ventilator also bring about unfavorable aspects to prevent complications later. 5, you can try Angong Niuhuang Pill, one capsule at a time after the gastric tube nasal feeding.