A Short Note On Hemorrhage ( Sah )

○ History and physical examination is suggestive of disease by explicit clinical criteria (i.e., hypertension, sudden onset of seizure, neurologic deficits, coma)·

The purpose of this case study is to examine the specific case study of a 40 year old male who suffered a traumatic brain injury as the result of a fall from a roof. For future reference the term "Traumatic Brain Injury" will be abbreviated here as TBI and "Intracranial Pressure" as ICP. In this study we will explore the medical findings that are common in such an injury and how they relate to the Paramedic in the field. The specificity of this case will be broken down to define relevant terminology and findings that were present to the paramedics that responded to this call. Lastly, TBI's will be explored and discussed for their relevance in the field, contributing factors and comorbidities as they relate to paramedicine.

1-Mr. Franklin had dizziness and was found on the floor. From his history, we know that two years ago he had a thrombotic cerebrovascular accident. The thrombotic cerebrovascular accident is unexpected death of some brain cells because of lack of oxygen when the blood supply to the brain is blocked by blood clots. This is also called stroke or CVA. This traumatic brain injury is related to blood vessel damage. Seizures and dizziness are some of the physical symptoms. We can rule out traumatic brain injuries like fluid buildup in the brain that could cause the brain to swell; skull fractures or wounds that can tear the meninges pooling blood outside the vessels and enabling the bacteria to infect the nervous system.

Different types of intracranial hemorrhages can occur due to injuries to the skull, either directly or indirectly. Epidural hematomas occur when a direct blow to the skull causes injury to the dural arteries or veins that lead to bleeding that accumulates between the dura matter and the skull. If the dural artery is injured, rapid deterioration of the patient neurologic status can occur. As the size of the epidural hematoma increases, the surrounding brain tissues is damaged due to the compression from the pressure of the blood accumulation. The patient may experience a dilated pupil on the side of the injury due to compression of the third cranial nerve. The patient may also complain of a severe headache, visual disturbances and weakness on the opposite side of the injury. If bleeding continues and increases the intracranial pressure, leading to brain shift or herniation of the brain stem which is irreversible and leads to hypertension, bradycardia and respiratory arrest. This trio of symptoms is called the Cushing’s Triad. Epidural hematomas can continue

Hemorrhages, or internal bleeding, account for a large portion of deaths in the world. Hemorrhages are an extremely life threatening injury that require immediate medical attention. These injuries are extremely sensitive to the time of injury and the time it takes for surgery to begin. Hemorrhages fall into two main categories: non-compressible and compressible. Compressible hemorrhages can be treated with external compression, tourniquets, and dressings. Non-compressible hemorrhages can not be treated with these techniques, because the injury is usually deep inside the abdominal part of the body and either not visible, or not within reach. This makes non-compressible hemorrhages much more challenging to treat.

Subdural or Epidural bleeding – as bleeding grows it pushes on brain which will mean you have difficulty communicating and moving.

Patient is a 23-year-old right-hand white female who presents with her mother for evaluation of post concussive syndrome. She had two significant closed head injuries this winter in February. They both occurred while snowboarding. On the first one, she slipped on some ice fell back and hit her occiput. She was wearing a helmet. When she got down to the bottom of the hill, she noted she had some mild confusion. Her friend asked her where she fell and she was unable to recall exactly where in the course she fell. She had a mild headache and was sleepy the rest of that day. One week later, she had another strike to the occiput. Again, she was wearing a helmet. She did have a headache

Signs and symptoms of a traumatic brain injury can be difficult to diagnose. Many of the signs and symptoms vary from person to person or they can take up to a couple of weeks before they surface (U.S. Department of Health and Human Services and Centers for Disease Control and Prevention, 2007). The signs and symptoms can range from minor signs like blurred vision to more serious signs like loss of consciousness. The signs and symptoms of a traumatic brain injury include: Headache, dizziness, nausea, vomiting (Clayton, 1995), unaware of place and time (Farrow, 2004), temporary or prolonged loss of consciousness, amnesia (memory loss), emotional instability, dilated pupils (Levy, 1993), balance problems, blurry vision, sensitivity to light and noise, sluggish or groggy feeling, or concentration problems (U.S. Department of Health and Human Services and Centers for Disease Control and Prevention, 2007). If an athlete has these symptoms they should get immediate medical attention. However, most of these symptoms can be signs of another health problem so they may not have a traumatic brain injury with these

TBI or Traumatic Brain Injuries can be caused by much more than just a fall. Their are eight types of TBI's and they are as follows. Open head injuries such as penetrating trauma, closed head injuries such as falls or hitting your head on something, Deceleration injuries that are caused by your brain smashing into the front of your skull and than bouncing back into the rear again, Chemical/Toxic injuries that are caused by insecticides, solvents or carbon monoxide, Hypoxia when your brain doesn't get enough oxygen, Tumors that disrupt and put pressure on the tissues in your brain, Infections that affect the surrounding membranes or brain itself, and finally strokes which could be considered similar to hypoxia since the clot prevents proper circulation of blood in the brain leading to the death of tissue.

Closed head injuries are caused by blunt trauma in which a concussion, contusion, and laceration to the brain may result. The most severe of the closed head injuries is anoxal injury (diffuse type). Diffuse anoxal injury is used related to high speed acceleration/deceleration as with automobile accidents. (Workman, 2006). With this type of injury there is significant damage to the axons in the white matter. Lesions may be found in the corpus callosum, midbrain, cerebellum and upper brainstem. Depending on the severity, small areas of hemorrhage followed by possible enlargement of the lateral ventricles may be detected on CT scan. For severe cases, the majority present in a coma. Survivors usually require long term care.

This patient most likely has a extradural (epidural) hematoma and the temporal fossa is the most common site of this type of hematoma caused by “injury to the middle meningeal artery or vein”(McCance & Huether, 2014, p. 584). “Expanding high-volume epidural hematomas can produce a midline shift and cause herniation of the brain. Compressed cerebral tissue can impinge on the third cranial nerve resulting in pupillary dilation and contralateral hemiparesis or extensor motor response”(Price, 2014, p. 3). Extradural hematomas are medical emergencies and surgical intervention is needed to remove the clot and reduce the pressure on the brain. Whether treated or untreated, this type of hematoma has an elevated risk of brain damage. However, left untreated, patients with extradural hematomas have a high risk of

Extensive research offers hope for the growing numbers of people suffering from traumatic brain injuries that often leave victims unable to return to their previous lifestyle and sometimes require long-term care. Traumatic brain injuries are quite common from car accidents, a blow to the head, sports accidents, and in military veterans. These injuries have a long term effect that changes lives of many individuals. Some brain injuries, even have the power to change the way one speaks and complete simple everyday tasks which restrict one to be independent.

It is also unclear if it is the brain injury itself that causes the result and if it is the same for healthy people.

In a subarachnoid hemorrhage, bleeding occurs within the space between the brain and the skull. This type of stroke accounts for about 7% of all strokes. A subarachnoid hemorrhage is often signaled by a sudden thunderclap headache thats more severe than any you have ever felt. About half of all people who experience a subarachnoid hemorrhage die. Half of those who survive are left

Hemorrhaging, some aged cuts opened back up on Frisk’s head and neck, maybe they reopened during eir sudden blackout. The bandages can only be reapplied so many times, after some contemplation, ey halfheartedly pulled at the swathes lining eir arms in a pile of red leaves. At the same time, a grotesque sight came rolling into view; scars, bright pink in contrast to eir white, but well-tanned skin, lining virtually every centimeter. Still, ey took the still surviving bandages and wrapped them around eir skull; in the end, ey ran out, however, it wasn’t enough. In light of this, eir scowl that formed during the process only became deeper, the only ones I have left are on my legs. In the end, ey started tugging at the layers of fiber around eir leg; only, ey came to see a scene even worse than eir arms.