Hawaii Personal Injury Blog - TBI

Billy May and TBI: Another Closed Head Injury Death?

Wayne Parsons — Mon, 29 Jun 2009 15:48:36 GMT

Doctors are looking at a traumatic brain injury (TBI) as the possible cause of the tragic death of TV actor Billy May as Mike Bryant of Minnesota has reported recently in:

Doctors Will Be Looking At Potential Head Injury With Billy May's Death.

Everyone should be on alert that a blow to the head can start a small bleeding process in the brain that is unknown to the person whose head was hit - and can lead to death. Often the person is either unconscious for a period of time, or dazed. After a few moments the person goes through what doctors call a lucid interval where they seem OK.

This article is about the medical sign. For the Cephalic Carnage album, see Lucid Interval.
In emergency medicine, a lucid interval is a temporary improvement in a patient's condition after a traumatic brain injury, after which the condition deteriorates. A lucid interval is especially indicative of an epidural hematoma. An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval.^[1]^[2] The lucid interval occurs after the patient is knocked out by the initial concussive force of the trauma, then lapses into unconsciousness again after recovery when bleeding causes the hematoma to expand past the point at which the body can no longer compensate.^[3] After the injury, the patient is momentarily dazed or knocked out, and then becomes relatively lucid for a period of time which can last minutes or hours.^[3] Thereafter there is rapid decline as the blood collects within the skull, causing a rise in intracranial pressure, which damages brain tissue. In addition, some patients may develop "pseudoaneurysms" after trauma which can eventually burst and bleed, a factor which might account for the delay in loss of consciousness.^[4]

Because a patient may have a lucid interval, any head trauma is regarded as a medical emergency and receives emergency medical treatment even if the patient is conscious.

Delayed cerebral edema, a very serious and potentially fatal condition in which the brain swells dramatically, may follow a lucid interval that occurs after a minor head trauma.^[5]

Lucid intervals may also occur in conditions other than traumatic brain injury, such as heat stroke^[6] and the postictal phase after a seizure in epileptic patients.^[7]

The skull is solid and the brain is soft. Increasing the pressure with an internal bleeding process is a catastrophe waiting to happen.

I handled a TBI case years ago that I will never forget. A man hit is head when he fell off a ladder in his yard while trimming a tree. His wife was with him and got to him immediately. His eyes were open but when she asked if he was hurt he did not respond. He never was "unconscious" as we usually think of it. That was at 9 o'clock in the morning. By 5 PM he was dead. He went to his family doctor who asked him some questions that he answered correctly. The doctor did not order a CT Scan.

The 20th century has seen critical developments in diagnosis and treatment which have decreased death rates and improved outcome. These include imaging techniques such as computed tomography and magnetic resonance imaging. Depending on the injury, treatment required may be minimal or may include interventions such as medications and emergency surgery. Physical therapy, speech therapy, and occupational therapy may be employed for rehabilitation.

During the afternoon the man slept at home and his headache worsened. He was unresponsive at 5 PM at home. Tragic. A CT scan might have shown the insidious bleed and treatment would have been available.

These head injuries are a leading cause of death in the United States from trauma:

Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.

Billy May was far too young to die. The first lesson is to get to a doctor or hospital immediately. The second is to look for the subtle signs and symptoms of an internal bleed in the head.

Originally posted at InjuryBoard by Wayne Parsons

Health Alert: Recognizing When Someone Is Having A Stroke Can Save Their Or Your Life

Wayne Parsons — Sun, 14 Jun 2009 16:07:00 GMT

STROKE IDENTIFICATION

We saw Natasha Richardson die of a traumatic brain injury (TBI) shortly after hitting her head on a ski slope. A short delay in recognizing the seriousness of her injury because she was alert and conscious, allowed the injury in her head to become fatal. There are many good resources about people who hit their head and suffer an obvious trauma or TBI, but a stroke often goes on without any outside influence. Something is happening inside the brain and the signs are subtle, even to the person having the stroke.

Think of Ms. Richardson when you become aware of the subtle signs of a stroke. Stroke is invisible often. No head trauma. No violent events. If you see a friend stumble and lose their balance or fall at a summer BBQ, ask yourself if perhaps this person - or you if it is you who stumbled - is having a stroke? Most people will assure everyone that they are fine will refuse assistance saying that they must have caught their foot on something. Calling for paramedics is out of the question they will say.

They will get up and the host will bring them a beverage or some food, and the embarrassed guest will go about enjoying the rest of the party. If it was a stroke you will get a call later that the person had been taken to the hospital later and sadly has passed away. If those who saw the person stumble and fall knew how to identify the signs of a stroke, perhaps death could have been prevented.

Here is what you need to know:

A neurologist says that if he can get to a stroke victim within 3 hours he can often totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE:

Commit to memory the '3' steps, STR - ask three simple questions:

S: Ask the individual to SMILE.

T: Ask the person to TALK and SPEAK A SIMPLE SENTENCE, coherently. (i.e.. It is sunny out today.)

R: Ask him or her to RAISE BOTH ARMS.

If he or she has trouble with ANY ONE of these tasks, call the emergency number (911 in many places) immediately and describe the symptoms to the dispatcher.

Another 'sign' of a stroke is to ask the person to 'stick' out his or her tongue. If the tongue is crooked, if it goes to one side or the other, that is also an indication of a stroke.

There are great resources on stroke and STR is not the only catch phrase for us to apply. How about F.A.S.T. as in do something FAST? That comes from the National Stroke Association:

If you think someone may be having a stroke, act F.A.S.T. and do this simple test:

Act F.A.S.T.

FACE
Ask the person to smile.

Does one side of the face droop?

ARMS
Ask the person to raise both arms.

Does one arm drift downward?

SPEECH
Ask the person to repeat a simple sentence.

Are the words slurred? Can he/she repeat the sentence correctly?

TIME
If the person shows any of these symptoms, time is important.

Call 911 or get to the hospital fast. Brain cells are dying.

Stroke Symptoms include:

SUDDEN numbness or weakness of face, arm or leg - especially on one side of the body.

SUDDEN confusion, trouble speaking or understanding.

SUDDEN trouble seeing in one or both eyes.

SUDDEN trouble walking, dizziness, loss of balance or coordination.

SUDDEN severe headache with no known cause.

Call 9-1-1 immediately if you have any of these symptoms

Note the time you experienced your first symptom. This information is important to your healthcare provider and can affect treatment decisions.

If you have experienced any of these symptoms, you may have had a TIA or mini-stroke.

Let others know about S.T.R. and F.A.S.T. -- Saving a life is a beautiful thing.

Originally posted at InjuryBoard by Wayne Parsons

Child On Guam Ejected From Car

Wayne Parsons — Sun, 26 Apr 2009 14:43:14 GMT

A 5-year-old boy was ejected from the passenger side of a car Friday morning. The car crash happened across from Our Lady of Peace and Safe Journey Church in Chalan Pagowho, Guam. The boy is in stable condition, said Guam Memorial Hospital nursing supervisor Josephine Eustaquio.

"He's awake and alert," she said. "He may be sent home soon."

The boy suffered a serious head trauma and was taken to GMH, said Guam Fire Department spokesman Capt. Joseph Flores according to the story reported in Guam Pacific Daily News.

He had surgery that afternoon for head trauma, GMH nursing supervisor Cely Mangrobang said on Friday. The boy was fortunate that a couple of brain surgeons visiting from Queens Medical Center in Hawaii were at the Tamuning hospital. Specialists from the Honolulu hospital make their periodic visits to Guam.

Originally posted at InjuryBoard by Wayne Parsons

Act F.A.S.T.
FACE	Ask the person to smile. Does one side of the face droop?
ARMS	Ask the person to raise both arms. Does one arm drift downward?
SPEECH	Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?
TIME	If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.