The Golden Hour (Scene 1)June 2012
Lesson 1: What is traumatic brain injury?
Accidents and unpredictability of the road
Accidents may not always be avoidable, but some of the associated injuries can be prevented. Though very common, driving a car is a potentially dangerous activity. A driver must be prepared to react at a moment’s notice, but often even this is not enough. Cars have several defenses against a collision-related accident. The metal frame of the vehicle holds its shape upon impact. Antilock brakes assist the car’s speed reduction. The car’s airbags deploy upon collision and provide a shock-absorbing balloon of expanding air. Seatbelts prepare drivers for the unexpected dangers of the road and could potentially save lives. But how often do you wear your seatbelt? We settle into daily routines and we may begin to underestimate the importance of everyday rituals, such as securing a seatbelt. If this happens, we may leave ourselves unprepared for the unpredictable behavior of the road. Other than the speed of the vehicle, a seatbelt is the injury prevention tool most directly influenced by the driver. The frame of the car may hold, and the airbags may deploy; but if a seatbelt is not worn, a bad situation can quickly become much worse.
Bridget Carmichael was returning home from her job late Thursday night. After a long day at work, Bridget was tired and anxious to sleep. Suddenly, a deer jumped in front of her car. Bridget, unable to stop in time, struck the deer and her vehicle sat still on the side of the road. Bridget was not wearing a seatbelt at the time of the crash. Although the vehicle’s airbags did deploy, the force of the impact flew Bridget forward and caused her head to strike. Her vehicle’s onboard navigation system automatically contacted emergency assistance. An ambulance arrived to find Bridget unconscious, but alive and breathing.
Bridget was taken to the hospital immediately. The paramedics were able to safely remove her from the vehicle and stabilize her vitals. The paramedics examined Bridget using the Glasgow Coma Scale. The Glasgow Coma Scale (GCS) assesses the Verbal, Motor, and Eye responses of a patient who may have sustained trauma. Bridget’s loss of consciousness was indicative of a low GCS score. She did not respond to verbal commands from the paramedics. She seemed to have little motor and eye response to pain. The paramedics assessed and recorded Bridget’s GCS scores: Verbal, 1, Motor, 1, and Eye, 1. Added up, this meant a low GCS score of 3. Fortunately, Bridget did not sustain any broken bones or fractures during the accident. The true extent of the injury, however, remained underneath the surface.
Once at the hospital, Bridget was examined by the emergency room staff. The paramedics notified the doctors of her accident, her vitals, and her GCS scores. The attending physician immediately suspected head trauma. Bridget’s CT scan showed several subdural hematomas and contusions in her frontal lobe and occipital lobes. Bridget had suffered a coup-contrecoup injury. During the crash, Bridget’s head struck the steering wheel. The force of the impact swung her brain forward toward the site of impact and then backwards toward the back of the skull. The collision of her brain with the front and back of her skull caused ruptured blood vessels and bruised nervous tissue. Bridget was sent to the operating room immediately. After several hours, neurosurgeons were successfully able to reduce the swelling around the sites of the impact, remove the contused brain tissue, and stop the bleeding.
The attending physician used the Glasgow Coma Scale to reexamine her cognitive responsiveness following the surgery. The day after the surgery, Bridget began to show some motor and eye response to stimuli. The physician assessed her GCS scores as Verbal 1, Motor 2, Eye 2. The improvements in Bridget’s GCS score, though small, indicated that her condition was improving. Doctors remained hopeful and continued to regularly test her cognitive responsiveness.
Finally, three days after her surgery, Bridget awoke in her hospital bed. However, she had little memory of the incident that brought her to the hospital. Doctors explained to her that she had been in a car accident and that she had suffered a traumatic brain injury. They explained that during the crash, her brain was bruised and began to bleed. The doctors then explained that while the surgery addressed the immediate complications from the accident, several follow-up neurological assessments would be needed to determine if her cognitive abilities returned to functional levels. For the time being, Bridget had sustained and survived a traumatic brain injury. She was fortunate that her onboard navigation system notified paramedics about the accident immediately and also that the team of surgeons was successfully able to complete the operation. But Bridget did not wear her seatbelt, and in doing so she took a great risk. Her life was saved by the skills and dedication of trained medical professionals. The timing of their involvement was crucial to Bridget’s outcome, but the treatment for traumatic brain injuries is not always immediately available (i.e. the paramedics may not arrive in time) or as effective (not all cases of traumatic brain injury can be as successfully addressed). Even so, prevention would have been a much more effective means of addressing the accident and traumatic brain injury. Daily commuters cannot always predict the behavior of the road. But a routine activity as simple as wearing a seatbelt can dramatically improve the outcome of an accident and potentially prevent a traumatic brain injury.
Article adapted from
Williams, Elizabeth. (2011, March 23). [Unknown]
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The Golden Hour (Scene 1)June 2012
Lesson 1: What is traumatic brain injury?
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