PDA

View Full Version : Head injuries: Looking for signs and acting quickly


ricki
03-29-2009, 07:23 AM
Just came across this:

http://www.nytimes.com/2009/03/26/fashion/26helmet.html?em

"Head injuries: Looking for signs and acting quickly
By Liz Robbins
Published: March 26, 2009

The 18-year-old runner was rounding third base for home so fast that his batting helmet flew off. The infielder rifled the ball to the catcher, but it caught the runner instead, hitting his suddenly bare head. He scored, walked to the dugout, and five minutes later began to experience a violent headache.

He had an epidural hematoma — the same bleeding in the brain that the 45-year-old actress Natasha Richardson fatally suffered last week after her innocent fall on a beginner ski slope in Quebec. And the circumstances seemed equally one in a million. But the young baseball player lived through his injury because the field was close to a hospital and he was taken there right away, and because Dr. Robert Cantu was able to operate quickly.

"This kind of blood clot we're dealing with here almost never happens in helmeted sports — unless the helmet comes off," said Dr. Cantu, a director of the Neurological Sports Injury Center at Brigham and Women's Hospital in Boston.

Ms. Richardson was not wearing a helmet when she fell and she suffered what the New York medical examiner described last week as a "blunt trauma to the head." She was initially lucid, the ski resort said, and declined treatment. Not until nearly four hours after the accident did her condition quickly deteriorate and Ms. Richardson was rushed to a local hospital hours outside Montreal. She died March 18 at Lenox Hill Hospital in Manhattan.

With the public shock surrounding Ms. Richardson's sudden death subsiding, the medical community, as well as parents and leaders of recreational, youth and college sports are taking harder looks at the inherent risks, and seeking lessons.

Traumatic brain injury — a blow to the head that disrupts the normal function of the brain — occurs yearly in recreational and organized sports in the United States at a rate of about 207,830 a year, according to a 2007 study by the Centers for Disease Control and Prevention. The C.D.C. said the exact number of fatalities is unknown but Dr. Cantu said deaths represent less than 1 percent of total injuries. The agency said children in sports are more likely than adults to have head injuries.

"Helmets, although they do not prevent concussion, have a virtually 100 percent record of preventing skull fractures," Dr. Cantu said. "Had she been wearing a helmet," he said of Ms. Richardson, "she would have been alive."

The type of fatal injury Ms. Richardson suffered is almost always caused by a fracture of the temporal bone, paper-thin compared to the rest of the skull, which in turn can cause an artery tear that sets up the possibility of rapid bleeding, Dr. Cantu said. While the medical examiner would not confirm a fracture, it is consistent with that kind of resulting hemorrhage.

Last season, 43 percent of skiers and snowboarders wore helmets, according to the National Ski Areas Association, up from 25 percent in 2002. Seventy percent of children 9 or younger wore helmets. There was an equally important lesson from the Richardson tragedy. "Never, ever, after a head injury," Dr. Cantu said, "should you not get checked out if the symptoms get worse."

The C.D.C. provides program tool kits, "Heads Up," for high school coaches to identify symptoms of concussions, including dizziness, confusion and slow response. The slogan? "It's better to miss one game than the season."

Michael Cott of Roslyn, N.Y., missed six months of club soccer after his second concussion in one week at a summer camp in 2003. An opponent, trying to head the ball, slammed Michael's forehead instead, knocking him unconscious.

Michael returned to play only after his father, Noel Cott, mandated that he wear padded headgear, made by Full 90; Michael was teased, but he and his father became converts to the cause.

Football and basketball lead the number of brain-injury-related emergency room visits, joining the recreational sports of skiing, bicycling, driving all-terrain vehicles, and playground activities, the C.D.C. reported.

In collegiate sports, a new study shows a higher incidence of concussions for women than men, led by women's ice hockey, said Dr. Margot Putukian, director of athletic medicine at Princeton University. Identifying a concussion, and soon, is key.

"It's so difficult when you have a mild injury, you might get fooled," Dr. Putukian said. "It is not always the body-to-body contact, but often concussions are quite subtle."

Darcy Strain wishes he could have seen the signs when his son, Ethan, 11, was fiercely checked from behind by a much larger 12-year-old in an ice hockey tournament in Chicago in January.

Ethan told his father he felt dizzy and had a headache after the game but felt well enough to play the next day. Mr. Strain, who lives in Houston and grew up in Manitoba playing on frozen ponds without a helmet, thought Ethan was fine.

But days later, neurological tests showed that Ethan had a concussion. He suffered debilitating headaches and loss of short-term memory and has been unable to attend school in eight weeks.

Mr. Strain bought Ethan a top-of-the-line helmet to wear after he is cleared to play again. And he urges friends to monitor their children's injuries. "It brings it all close to home when that actress passed away with a little bump on the head from falling on a ski slope," Mr. Strain said, his voice quavering in a phone interview. "There's a reason why a little bump got her — everything went wrong that could have gone wrong. You don't realize it could happen, until it happens to you.""

ricki
03-29-2009, 10:54 AM
Someone is lofted or dragged to impact, often enough they may try to convince you and themselves that they are OK. This from personal experience and other stories I have heard about. The simple solution is to call for medical attention and have them evaluate the guy properly. This approach isn't used all the time, victims sometimes just want to walk it off (concussion and perhaps brain hemorrhage?!). There was at least one lofting victim who may well have suffered paralysis from this course of action.

So what to do? Call the EMTs, even if it means overruling the victim in what may be a serious case. . If that isn't going to happen for whatever reason, good one or not, carefully consider the following from the CDC. btw, the victim should be immobile until help arrives with his neck held motionless along with other first aid as indicated

"One method to categorize victims of head injury is to consider them to be divided into two groups, according to whether or not they have lost consciousness. If a victim has not lost consciousness, this implies a lesser injury, but like everything in medicine, is not infallible. If someone has lost consciousness, even for a few seconds, the red flag is up for a potentially serious injury. Always be aware that the dazed or unconscious victim cannot protect his airway; you must be vigilant in your observation. The most common dangerous complication of head injury is obstruction of the airway with the tongue, blood, or vomitus. The most common associated serious injury is a broken neck.

Loss of Consciousness

If a person struck in the head has lost consciousness, he has suffered at least a concussion. The following signs and symptoms are commonly associated with a concussion: unaware of what happened; confusion; loss of memory; loss of consciousness; headache or sensation of pressure in the head; dizziness; balance problems; nausea; vomiting; feeling “foggy,” “dazed,” or “stunned;” visual problems (e.g., seeing stars or flashing lights, or seeing double); hearing problems (e.g., ringing in the ears); irritability or emotional changes; slowness or fatigue; inability to follow directions or slow to answer questions; easily distracted or poor concentration; inappropriate emotioinal behavior; glassy-eyed or vacant starting; slurred speech; seizure.

1. Protect the airway and cervical spine.

2. If the victim wakes up after no more than a minute or two and quickly regains his normal mental status and physical abilities, he has probably suffered a minor injury—so long as there is no relapse into unconsciousness or persistent lethargy, nausea or vomiting, or severe headache. If the victim is far from help, he should undertake no vigorous activity and be kept under close observation for at least 24 hours. Normal sleep should be interrupted every 2 to 3 hours to briefly ensure that his condition has not deteriorated. Confusion or amnesia for the event that caused the blackout is not uncommon and not necessarily serious, so long as the confusion does not persist for more than 30 minutes. Because a serious brain injury may not become apparent for hours, the wilderness traveler who has been "knocked out" should not venture farther from civilization for 24 hours. If headache and/or nausea persist beyond 2 to 3 hours, or if the victim seems in any way altered with respect to mental status, the victim should begin to make his way (assisted by rescuers) to medical care.

If the injury is minor and evacuation is not undertaken, advance the victim’s activity as follows: no activity and complete rest until without symptoms; next, light walking without any heavy lifting or resistance activity; next, mild exercise with slight resistance; finally, full activity. Do not progress beyond one “level” each 24 hour period.

3. If the victim wakes up and is at first completely normal, only to become drowsy or disoriented, or lapses back into unconsciousness (typically, after 30 to 60 minutes of normal behavior), he should be evacuated and rushed to a hospital. This may indicate bleeding from an artery inside the skull, causing an expanding blood clot (epidural hematoma) that compresses the brain. Frequently, the unconscious victim with an epidural hematoma will be noted to have one pupil significantly larger than the other.

4. If the victim awakens but has a severe headache, bleeding from the ears or nose with no obvious external injury to those organs, clear fluid draining from the ear or nose, unequal-sized or poorly reactive (do not constrict promptly upon exposure to bright light) pupils, weakness, bruising behind the ears or under the eyes, vomiting, or persistent drowsiness, he might have a skull fracture. Such signs mandate immediate evacuation to a medical facility.

5. If the victim suffers a seizure after a head injury, no matter how brief, he should be transported to a medical facility.

6. If the victim does not wake up promptly after a head injury (unconscious for more than 10 minutes), has bleeding from an ear, has unequal or nonreactive (do not constrict to bright light) pupils, has clear fluid from the nose, has a profound headache, is weak in an arm or leg, is disoriented, or has a fluctuating level of consciousness (normal one minute, drowsy the next), he may have suffered a significant brain injury and should be immediately rushed to a medical facility. Because there is a high incidence of associated neck injuries, any person with a serious head injury should have his cervical spine immobilized. Head injuries often cause vomiting. Therefore, be prepared to turn the victim on his side so that he doesn’t choke."

From: http://tinyurl.com/5kvvrk

ricki
03-29-2009, 10:54 AM
I started looking for a general reference like this dealing the head injuries after a tragic accident in Mauritius several years ago. The vacationing Russian kiter suffered a board impact in squally weather due to the use of a board leash. He had a brain hemorrhage but didn't realize it as his life bled out. I really didn't find a good, concise reference from an authoritative source at the time. Nor did I realize the import of my head injury as I stomped around for hours for that matter however things turned out to be more benign in my case. The victim often is the last to know after all much less react responsibly. This post is more for bystanders of such accidents to serve as a guide. We really should think about this stuff as you never know when you might be on the scene of a head/cervical injury and in a position to help. There have been other cases in which paralysis may have been avoided through immobility or brought about by "walking it off" assuming the victim was even aware at the time.

ricki
03-29-2009, 10:55 AM
As a following up to the article from the NY Times, "Head injuries: Looking for signs and acting quickly"
http://www.nytimes.com/2009/03/26/fashi ... ml?_r=1&em


It is worth reading over. Some points come out.

- Wearing a good helmet, that is well secured.

Helmets can come off in an impact, the fastening system and fit may determine if this happens or not. You want your helmet to stay on your head where it can do some good.

- People with serious head injury (epidural hematoma) may have a deceptive "lucid interval."

After a serious head impact, they may seem to be ok, may even try to convince you they are. They may have a brain hemorrhage and may enter into a coma in time. They may even more around quite a lot making things worse. I stomped around for 4 to 5 hours with an epidural hematoma after a bad lofting, convinced several bystanders I was ok before getting medical treatment in the ICU. Beyond that they can aggravate cervical trauma which could result in paralysis by moving. This may have happened to other kiteboarders in past accidents.

More about Epidural Hematoma (shallow brain hemorrhage) at:
http://en.wikipedia.org/wiki/Epidural_hematoma


Short version, have a head injury, think carefully about having it checked out. This applies more to bystanders than the kiter as he may well already "be off his head" but may not know it. False alarms possible, maybe, but for folks like Natasha Richardson and the Russian tourist, there was no effective response and they died as a result. Also, wear a GOOD WELL SECURED lid appropriate for kiteboarding.


p.s. - want to see what an Epidural Hematoma looks like? I elected not to embed this image up because it is pretty intense. If you aren't worried about the consequences of a head impact, perhaps you should have a look at this. The dark red section is the area of injury. I've had one of these, a lesser version I think, a number of us have worldwide. It is a good thing to try to avoid.

http://www.neuropathologyweb.org/chapter4/images4/4-1L.JPG