- Email: [email protected]
Head-injured patients who talk
Injury, 7, 315-318
315
Abstracts I n j u r i e s o f h e a d and s p i n e
Outcome of severe brain damage
Mechanics of head injury
Severe damage to the brain is now well recognized as a cause of serious and lasting disability that imposes heavy burdens upon individuals and also upon the State. The authors have found a 5-grade scale of disability, both practicable and useful, and offer it for general consideration. I. Death. 2. Persistent vegetative state. 3. Severe disability with complete or nearly complete dependence on others but perhaps some working ability. 4. Moderate disability, which allows independence and travelling by public transport. 5. Good recovery. These 5 grades require no separate assessment of mental and physical handicap and take account of both. JENNETT B. and BOND M. (1975) Assessment of outcome after severe brain damage. Lancet 1, 480.
In this article an opinion is expressed, and supporting references cited, on the forces which are likely to develop in the brain, and between the brain and skull, in head injury. Causation of the different types of lesions is also discussed. GURDJIAN E. S. and GURDJIAN g. S. (1975) Reevaluation of the biomechanics of blunt impact injury of the head. Surg. Gynecol. Obstet. 140, 845.
Management of head injuries Patterns of management for head injury in the acute and late stages are reviewed in respect of both mild and severe injuries. Because so many disciplines are involved, continuity of care is often difficult to achieve, and no one discipline is concerned with planning for the care of head injuries in a strategic way. The needs of head-injured patients are defined and suggestions made for improving care by the reorganization of existing facilities. What is most needed is to concentrate on patients with head injuries, both in the acute and late stages. Only then can medical, nursing and paramedical personnel become skilled in dealing with the many problems which such patients present. JENNETT B. (1975) Who cares for head injuries? Br. Med. Y. 3, 267.
Head-injured patients who talk The authors are careful not to refer to consciousness, about which there can be doubt, but to talking; of which, whether clear or mumbled, there is no doubt. Sixty-six victims of cerebral injury talked before they died of the injury and 25 per cent were found not to have intracranial haematomata. Nearly half of these had ischaemic or hypoxic damage, usually without either local or diffuse contusion. The danger of status epilepticus as a cause of destructive cerebral hypoxia was emphasized and occurred in 3 children. Deaths without increase in the intracranial pressure were most often caused by meningitis. Excluding an intracranial haematoma does not relieve the doctors in charge of finding the cause of neurological deterioration and doing what they can to relieve it, most often by lowering intracranial pressure. REILLY P. L., ADAMS J. H., GRAHAM D. I. and JENNETT B. (1975) Patients with head injury who talk and die. Lancet 2, 375.
Workshop for survivors of head injury The author describes the purpose of the workshop and the difficulties experienced in establishing and maintaining it. It serves as a sheltered workshop for those with no prospect of ordinary employment as well as a centre for the rehabilitation of those who will go back to work, LONDON P. S. (1975) Workshop for the disabled survivors of severe head injury. Br. Med. J. 3, 393.
Blast injuries of the ear Injury by blast is to be distinguished from deafness caused by a very noisy background or by loud reports. Blast ruptures one or both tympanic membranes, and as well as damaging the auditory ossicles it may impel a fragment of membrane into the middle ear, where it later forms a cholesteatoma. Deafness may pass off within a few hours, but any remaining deafness will affect high tones particularly and in mild cases it may go unrecognized. In some cases natural deafness of long standing is recognized later and blamed on an explosion. Tinnitus is a frequent and troublesome sequel but dizziness is usually a result of damage to the head. Ear plugs offer no protection, unlike ear pads. Most tympanic membranes healed without treatment, but after 3 months or so an unhealed membrane should be repaired. Dextran 40 and steroids given early may assist recovery from deafness.
315
Abstracts I n j u r i e s o f h e a d and s p i n e
Outcome of severe brain damage
Mechanics of head injury
Severe damage to the brain is now well recognized as a cause of serious and lasting disability that imposes heavy burdens upon individuals and also upon the State. The authors have found a 5-grade scale of disability, both practicable and useful, and offer it for general consideration. I. Death. 2. Persistent vegetative state. 3. Severe disability with complete or nearly complete dependence on others but perhaps some working ability. 4. Moderate disability, which allows independence and travelling by public transport. 5. Good recovery. These 5 grades require no separate assessment of mental and physical handicap and take account of both. JENNETT B. and BOND M. (1975) Assessment of outcome after severe brain damage. Lancet 1, 480.
In this article an opinion is expressed, and supporting references cited, on the forces which are likely to develop in the brain, and between the brain and skull, in head injury. Causation of the different types of lesions is also discussed. GURDJIAN E. S. and GURDJIAN g. S. (1975) Reevaluation of the biomechanics of blunt impact injury of the head. Surg. Gynecol. Obstet. 140, 845.
Management of head injuries Patterns of management for head injury in the acute and late stages are reviewed in respect of both mild and severe injuries. Because so many disciplines are involved, continuity of care is often difficult to achieve, and no one discipline is concerned with planning for the care of head injuries in a strategic way. The needs of head-injured patients are defined and suggestions made for improving care by the reorganization of existing facilities. What is most needed is to concentrate on patients with head injuries, both in the acute and late stages. Only then can medical, nursing and paramedical personnel become skilled in dealing with the many problems which such patients present. JENNETT B. (1975) Who cares for head injuries? Br. Med. Y. 3, 267.
Head-injured patients who talk The authors are careful not to refer to consciousness, about which there can be doubt, but to talking; of which, whether clear or mumbled, there is no doubt. Sixty-six victims of cerebral injury talked before they died of the injury and 25 per cent were found not to have intracranial haematomata. Nearly half of these had ischaemic or hypoxic damage, usually without either local or diffuse contusion. The danger of status epilepticus as a cause of destructive cerebral hypoxia was emphasized and occurred in 3 children. Deaths without increase in the intracranial pressure were most often caused by meningitis. Excluding an intracranial haematoma does not relieve the doctors in charge of finding the cause of neurological deterioration and doing what they can to relieve it, most often by lowering intracranial pressure. REILLY P. L., ADAMS J. H., GRAHAM D. I. and JENNETT B. (1975) Patients with head injury who talk and die. Lancet 2, 375.
Workshop for survivors of head injury The author describes the purpose of the workshop and the difficulties experienced in establishing and maintaining it. It serves as a sheltered workshop for those with no prospect of ordinary employment as well as a centre for the rehabilitation of those who will go back to work, LONDON P. S. (1975) Workshop for the disabled survivors of severe head injury. Br. Med. J. 3, 393.
Blast injuries of the ear Injury by blast is to be distinguished from deafness caused by a very noisy background or by loud reports. Blast ruptures one or both tympanic membranes, and as well as damaging the auditory ossicles it may impel a fragment of membrane into the middle ear, where it later forms a cholesteatoma. Deafness may pass off within a few hours, but any remaining deafness will affect high tones particularly and in mild cases it may go unrecognized. In some cases natural deafness of long standing is recognized later and blamed on an explosion. Tinnitus is a frequent and troublesome sequel but dizziness is usually a result of damage to the head. Ear plugs offer no protection, unlike ear pads. Most tympanic membranes healed without treatment, but after 3 months or so an unhealed membrane should be repaired. Dextran 40 and steroids given early may assist recovery from deafness.