Page 2 of 2 FirstFirst 1 2
Results 26 to 30 of 30
  1. #26
    Join Date
    Oct 2003
    Location
    Seattle
    Posts
    27,308
    How come now everyone refers to "CT scans" rather than CAT scans? did the cats' union complain or something?

  2. #27
    Join Date
    Mar 2008
    Location
    SL.UT (CWH, bra)
    Posts
    433
    CAT = Computed Axial Tomography
    now shortened to CT = Computerized Tomography

    Wikipedia, JONG

    As for the OP...

    As an EMT-B, here are the things I look at.

    -PUPILS - we use the acronym PERRL.. Pupils Equal, Round, Reactive to Light. Equal is good, If you can check their reactivity to light, either by holding a hand over their eyes for a sec to dilate them, or shine a light on them to constrict them, great. If they are "Blown" - fixed and dilated, that is a very bad, and very late sign of brain injury.

    - did they lose consciousness, and if so, for how long

    Then, the finer points of consciousness:

    -Level of Consciousness...
    -Alert and Oriented to:
    -Person? their name
    -Place? clear idea of where they are, not just "the hill" or other obvious answers)
    -Time? (day, date, year, president or other)
    -Events? Can they tell you exactly what happened

    If they are not alert to any of the above, then they could be alert to:

    -Verbal Stimuli (scream in your buddy's ear that Hillary Clinton wants to give
    him a BJ, if he moans indiscernably, he's still verbally responsive)
    -Painful Stimuli (pinch... sternal noogie, kick in the balls. Any movement or groan in reaction to it is considered a response)

    or they could still be
    -Unresponsive

    These will help quantify the state of your pt's brain, especially if it is variable... ie are they becoming more and more aware, or are they forgetting things you told them 1 min ago...

    By the sounds of the original question, the OP seems to assume a minor bump with or without initial Loss of Consciousness

    If your buddy lost consciousness (was unresponsive to verbal stimuli) for more than 5 minutes, this is a significant issue (ie get the heli) or so I've been told. Anything less should probably still be checked out... Jim S might fill in that info gap better than I.

    Also, as others have stated in this thread, there are many, many variables. Blood thinners, prior "stacked" concussions (VERY bad), hx of seizure, etc can all change your treatment plan significantly. But for the lay person, if you know of any such conditions that you think may interact with the brain injury... when in doubt, check it out.

    As far as your buddy that bumped his head and lost consciousness for less then 5 mins, and is now fully alert, and remembers everything except for the period of unconsciousness...

    -Is he acting normally?
    call it the "DICHEAD syndrome"
    -Disorientation
    -Irritability
    -Combativeness
    -HEADache - do they complain of a persistent headache
    If they have a headache, or are acting abnormally, these are all signs and symptoms of increasing Intracranial Pressure ie a brain bleed of some sort that needs to be seen STAT.

    In summary...

    -Alert & Oriented to: Person/Place/Time/Events
    Verbal Stimuli
    Painful Stimuli
    Unresponsive

    -Anything less than fully oriented to PPT&E = get them checked.

    -Loss of Consciousness >5mins = BAD get them checked.

    -Are they being a DICHEAD? Yes = Get them checked.
    Disorientation
    Irritability
    Combativeness
    HEADache

    -Pupils anything other than completely normal = get them checked.

    -History of Blood Thinners(heavy NSAID use/coumadin/aspirin), any prior concussions etc = get them checked.

    Nothing really hard and fast and easy for the lay person, but at least a few tools to quantify things. The more symptoms you see, and the more obvious they are, the more serious it probably is.



    As for the getting your head scanned and whatnot, I'd have to take Jim S's side and say that I've rarely heard of any doc erring on the side of underexamination... It's waaaaayyy harder to talk 99.99% of docs OUT of doing a CT/MRI than it is to talk them into it. They make money by performing the procedure...

    Again, from the perspective of an EMT-B, not a neurosurgeon
    Last edited by awake1563; 03-21-2009 at 10:31 PM. Reason: PERRL & Stacked Concussions
    but I know we can't all stay here forever, so I wanna write my words on the face of today...

  3. #28
    Join Date
    Jan 2009
    Location
    North coast
    Posts
    136
    ^^^^^^^^

    Great post. That is what this thread needed. Hopefully ski patrollers know everything an EMT does with respect to this? Probably, but so should everyone out there so they can help friends. Good stuff.

  4. #29
    Join Date
    Jan 2008
    Location
    Indiana
    Posts
    557
    ^^^ From what I understand OEC is built off of the DOT curriculum for EMT-Basic, with emphasis given on what pertains to outdoor rescues and skiing injuries.

    JimS - Thank you. My doc said about the same thing after that thread, but didn't see a need to suggest I stop biking or skiing despite taking some NSAIDs for my shoulder.

    Nohills - PM sent.

    --------------

    I asked about old injuries out of curiosity. I've had some bad blows that I did not get checked out for until much later that have caused some minor issues that never went away.

    I took a hard blow to the Occipital region of my skull, briefly lost consciousness, 1-2 mins per a patroller who saw me crash, and initially felt decent. I had a headache, but didn't see the need to an ambulance to be called. I left the hill, and kept getting worse over the next few days. I couldn't remember anything for very long. I was a bartender and had to write down drink orders, because I couldn't remember them by the time I got a glass. I was dizzy and throwing up a lot for the next few weeks. Ever since, my hands tremble a little, which causes some minor problems with my job. I have nystagmus (twitching) in one eye, without being drunk, and also have a small bump on the back of my skull that never went away after this injury.

    Knowing what I know now, not letting them call an ambulance for me was probably the dumbest thing I have ever done, and I'm damn lucky. But I was just wondering if an injury like that would show up in the future.

    [/blog]

  5. #30
    Join Date
    Nov 2005
    Location
    Land of Brine Shrimp and Magic Underwear
    Posts
    6,761
    Quote Originally Posted by emtnate View Post
    ^^^ From what I understand OEC is built off of the DOT curriculum for EMT-Basic, with emphasis given on what pertains to outdoor rescues and skiing injuries.

    JimS - Thank you. My doc said about the same thing after that thread, but didn't see a need to suggest I stop biking or skiing despite taking some NSAIDs for my shoulder.

    Nohills - PM sent.

    --------------

    I asked about old injuries out of curiosity. I've had some bad blows that I did not get checked out for until much later that have caused some minor issues that never went away.

    I took a hard blow to the Occipital region of my skull, briefly lost consciousness, 1-2 mins per a patroller who saw me crash, and initially felt decent. I had a headache, but didn't see the need to an ambulance to be called. I left the hill, and kept getting worse over the next few days. I couldn't remember anything for very long. I was a bartender and had to write down drink orders, because I couldn't remember them by the time I got a glass. I was dizzy and throwing up a lot for the next few weeks. Ever since, my hands tremble a little, which causes some minor problems with my job. I have nystagmus (twitching) in one eye, without being drunk, and also have a small bump on the back of my skull that never went away after this injury.

    Knowing what I know now, not letting them call an ambulance for me was probably the dumbest thing I have ever done, and I'm damn lucky. But I was just wondering if an injury like that would show up in the future.

    [/blog]
    Not really though, OEC is more equivalent to WFR and is (or was) a 40 hour course, while EMT-B is a 120 hour course. That said, fuctionally, they're not a whole lot different and I'd still rather have an experienced OEC patroller care for me than a green EMT-B patroller.

    I've got a scary history with this stuff too and it makes me nervous. I had a mountain bike crash in like '96 with LOC for an unknown amount of time and patchy memory for a couple hours afterward. My helmet was in pieces and I just went home, took a shower and went to bed. This is on top of a basal skull fracture from BMXing without a helmet when I was 14. Got the full workup for that of course. Add to those the countless other hard, flat landings, with or without knees to face I've taken since. Oh yeah and another broken bike helmet two years ago.

    No wonder I need to take off my shoes to count over than 10.

    Seriously though, this stuff can happen to anyone, Mrs. Richardson didn't seem like the type to have a history significant for head trauma. The fact of the matter is, anatomical malformations can go undetected until they burst for no reason someday. Or you can hit just right. Or you can take a huge high speed whopper and have LOC/short-term memory loss and be fine. I work in Critical Care at a level 1 trauma center, I see all this stuff all the time.

    Bottom line, be careful of your noggin. Get checked out if you have any symptoms (listed above) at all. Wear a helmet, it may not save you from that tree at 40 mph but it will tip the odds in your favor.
    There's nothing better than sliding down snow, and flying through the air

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •