A story of amazing courage.

I have a new client at work.  He is a 26 year old male. I cannot tell you his name because of privacy, but this young man is an amazing character.  He was working on a boat lift about 2 hours north of here.  Per him he was doing some electrical work when the cable broke and the boat fell on his foot and he was pinned and bleeding and his leg was a filet. His other foot was cut. He called for help.  The owner of the house came to his aid and he told the guy to go and get him a tourniquet and call 911. Meanwhile he took off his shirt and created pressure around his thigh.  The owner came back with a belt and told him that he had called 911.  This client took the belt and wrapped his leg and pulled it tight.  They got another belt and did the same to the other leg.

This guy was talking the whole time.  He asked the home owner if he had called for a chopper.  The home owner told him he had called 911.  My client used his cell phone and called 911 himself and told them he needed a chopper.  The 911 operator asked are you sure you need a helicopter, and this guy says yes, my foots almost off and I am bleeding bad.  They ultimately ambulance him out and get him to the nearest hospital and then helicopter him to a trauma center.

The kicker of this whole story is that this guy, never passes out.  He keeps pressure to both of his legs. He looses something like only a pint of blood, and he takes pictures while all this is going on.  The paramedics boasted that he was posting on Facebook using his droid phone while he was in the helicopter. Amazing.

He is one of the nicest most polite patients I have ever had.  They had reattached his foot. He is looking at probably a year and several more surgeries before he can walk on his foot. But amazingly he can move his toes. He looks really good and has an awesome attitude and an unrelenting spirit. If he was my son, I would be incredibly proud.  This just goes to show you that you should never give up, even in the face of the worst situation.

Well, that is my snippet for today.  I hope you all enjoy the story.

So what is Brain Injury anyway?

Brain Injury can be described in several ways.  Brain Injury from a cause such as a hit on the head.  This is termed Traumatic Brain Injury.  There can be brain injury from a stroke or Cerebral Vascular Accident (CVA). This kind of brain injury usually comes in 2 forms.  Embolic (a clot), or hemorrhagic (a bleed).  There is also another kind of brain injury called an anoxic brain injury.  This is when you get too little oxygen to the brain.  This happens in choking, drug overdose, drowning, hanging, etc. There are other examples that fall in the category known as open, or closed head injuries, penetrating injuries, etc. I don't want to get too detailed in this discussion, so I am keeping things just to the basics.

Today I am going to focus on the one kind of brain injury.  This is Traumatic Brain Injury.  Traumatic Brain Injury can be classified as 3 different categories.  Mild, moderate, and severe.

MILD Traumatic Brain Injury, probably is the most common.  You might fall, just hit your head and you might not have any real issues.  You however, feel like you are just not right for a day or more.  We used to refer to this as having a concussion.  The symptoms usually go away in a few days, but can last longer.  I want to caution you that you really should seek medical attention for any head injury.  Don't diagnose it yourself. Go and talk to your doctor! If you have lost consciousness, go to an emergency department or urgent care.

My girlfriends daughter was sliding down a slide at school and another girl met her at the bottom with a cement brick to the head.  My friends daughter Mic said she blacked out for a moment.  The other kid ran.  This is an example of a mild traumatic brain injury.  (kids can be tough). My friend called me right away and I sent them to the ER.  Yes, I know it inconvenient.  Yes, you will be there for a while.  Yes, most likely they will do a CT scan to make sure there is no bleeding inside the brain.  As long as everything looks fine on the scan and there is no "clinical Picture", like headache, blurred vision, change in speech, change in consciousness, inability to walk or difficulty walking in general, they will send you home.  If you have any of these symptoms they will watch you or your family member for a while. For the record, Mic was sent home later that day and she is doing fine.

How severe the TBI is may go from MILD; a short term change in how you think for a brief change in your consciousness to SEVERE; a longer period of being unconscious or not remembering the event (amnesia). Several articles have reported that 80% of TBI cases are classified as mild, 10% are MODERATE, and 10% are severe.

In my next post I will talk about MODERATE and SEVERE Traumatic Brain Injury.

Hope to see you soon.

Suzicho12

I wanted to pass on this article on Trauma Mortality to anyone who is interested in reading. This was posted on Medscape and I think it is appropriate for this month topic of Brain Injury Awareness. There are a lot of topics out on Medscape all with interesting reads.  Health care professionals can get CEU's.  Take a look.  You can follow on Facebook or twitter.

Kind of off topic this week is me.  I have been sick for about 6 weeks with a flu like virus. I have missed about 8 days of work now and have been stuck on my couch.  Can't even seem to get up long enough to do anything.  I have been tested for almost everything, but nothing has shown up.  Kind of strange since I can't seem to be able to walk to my mail box without even becoming short of breath and diaphoretic.  At least I am not coughing now.  That was a big issue.  Slept in a chair for about 2 weeks.

Any way, As most of you know I work at Courage Center.  I miss my patients and all of our great staff.  I recently was at the Emergency Room, and the nurse asked me how can you work there.  I told her, because everyday I see miracles.  I really do.  When I worked in trauma, as a nurse coordinator, I saw death weekly.  Could not stand to watch people have to make the decisions on their loved ones wishes to live or die.  I became distant and untouched by what I saw.  That was my signal that I needed to do something else.

She told me about how she had seen our patients out on the ski kill and could not believe their courage.  She said the ski lift would be daunting for someone with a disability. She could not believe that these people did it, and all with a disability. I said, see...miracles!

One of the biggest challenges of working with patients in rehab is watching them at their starting point.  See what they are like when they come in. After most people have been in a coma, they say their first memories start when they are in rehab.  I have heard this over and over again.  

I have seen where they come from, I have been on the other side in the ICU.  Patients who become lines and ventilators and medication and pressure monitoring, fevers and unconsciousness.  In essence their trauma diagnosis. The battle for life and death.  The battle to save some resemblance of the person who was here. I have seen the despair of families, and the decision to stop and not do any more. I have also seen the despair of continuing on and living with that decision. That is where new life and chances begin.

Suziecho12

Authors and Disclosures

Journalist

Jim Kling

Jim Kling is a freelance writer for Medscape.

Disclosure: Jim Kling has disclosed no relevant financial relationships.

From Medscape Medical News

Mortality Rate High in Trauma Patients

Jim Kling

March 11, 2011 — After admission for trauma, adults experience a 16% cumulative mortality rate during the next 3 years compared with an expected 6% for the general population, according to a study published in the March 9 issue of JAMA. Higher mortality rates were associated with discharge to a skilled nursing facility, regardless of patient age.

Most studies of trauma outcomes have focused on in-hospital mortality and complications, and there are few data available on long-term outcomes. Giana H. Davidson, MD, MPH, from Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle, and colleagues conducted a retrospective cohort study of 124,421 injured adult patients from January 1995 to December 2008. Patient data were obtained from the Washington State Trauma Registry, linked to death certificate data. The researchers used Kaplan-Meier and Cox proportional hazards models for data analysis.

Of the patients, 7243 died before hospital discharge, and 21,045 died after hospital discharge. Three years after injury, the cumulative mortality rate was 16% (95% confidence interval [CI], 15.8% - 16.2%) compared with a cumulative mortality of 5.9% (95% CI, 5.9% - 5.9%) for the general population.

During the study period, the researchers found that in-hospital mortality improved from 8% (n = 362; 95% CI, 7.2% - 8.8%) to 4.9% (n = 600; 95% CI, 4.5% - 5.2%).

After adjustment for confounders, the researchers found that discharge to skilled nursing facilities was associated with higher cumulative risk for death (adjusted hazard ratio, 1.41 [95% CI, 0.72 - 2.76] for patients aged 18 to 30 years, 1.92 [95% CI, 1.36 - 2.73] for patients aged 31 to 45 years, 2.02 [95% CI, 1.39 - 2.93] for patients aged 46 to 55 years, 1.93 [95% CI, 1.40 - 2.64] for patients aged 56 to 65 years, 1.49 [95% CI, 1.14 - 1.94] for patients aged 66 to 75 years, 1.54 [95% CI, 1.27 - 1.87] for patients aged 76 to 80 years, and 1.38 [95% CI, 1.09 - 1.74] for patients older than 80 years).

Other predictors of mortality included

• maximum head injury score on Abbreviated Injury Score scale (hazard ratio [HR], 1.20; 95% CI, 1.13 - 1.26),
• Injury Severity Score (HR, 0.98; 95% CI, 0.97 - 0.98),
• Functional Independence Measure (HR, 0.89; 95% CI, 0.88 - 0.91),
• injury resulting from a fall (HR, 1.43; 95% CI, 1.30 - 1.58),
• having Medicare (HR, 1.28; 95% CI, 1.15 - 1.43), or
• having other government insurance (HR, 1.65; 95% CI, 1.47 - 1.85).

"Despite increases in federal regulations intended to improve skilled nursing facility care, there has been insufficient impact on quality or public reputation. Further investigation is needed to determine if more health clinician oversight, funding, or rehabilitation therapy is needed to improve the care of the patients at skilled nursing facilities following discharge for injury," the authors write.

The authors have disclosed no relevant financial relationships.

JAMA. 2011;305:1001-1007. Abstract

Medscape Medical News © 2011 WebMD, LLC
Send comments and news tips to news@medscape.net.

 

March is Brain Injury Awareness Month!

Hi my name is Suzi.  I have been a nurse for 20 years.  Most of my career has been working in Neurosurgery in some capacity.  I started out working in the Neurosurgical ICU.  I have worked Radiology, and Cath Lab as well along with research of various types.

I am starting this blog, because I want to help people who might have questions about brain or spinal cord injury. I don't know where this will lead, but I feel I have something to say and to give back.

My goal is to try and post several times a week and answer any questions that I come up.  I am not a doctor or a nurse practitioner, so if you have a medical emergency call 911.

My topic this week is obviously Brain Injury.  March is Brain Injury Awareness Month.  Brain injury is a silent epidemic.  It affects not only the person who is being affected, but their family, children, significant others.


Among children ages 0 to 14 years, TBI results
in an estimated:
- 2,685 deaths;
- 37,000 hospitalizations; and
- 435,000 emergency department visits.


Of the 1.4 million who sustain a TBI each
year in the United States:
- 50,000 die;
- 235,000 are hospitalized; and
- 1.1 million are treated and released
from an emergency department.


The signs and symptoms of a traumatic brain injury can be subtle.
Symptoms of a TBI may not appear
until days or weeks following the injury or may even be missed as people
may look fine even though they may
act or feel differently.

Justin Morneau is a great example of this. He had his injury months back.  He looks good. He even went for batting practice, but he is not quite ready.  He will be though.  Obviously, I am a Twins fan.  GO TWINS!

For years after someone sustained a bonk on the head while in sports, they got up and kept going. Coaches would send them back into the game. You might fall, hit your head and get up.  Brain Injury is cumulative.  Which means the more times you get hit the worse the damage can become over time.

It is important to teach that it is not ok to go back into the game.  If you don't rest, You don't heal.  First rule of brain injury.

That's all for my start.  Ask questions, talk to me.  I will try and get back to you as soon as I can.

SuziEcho12