Calling doctors: brain damage/coma after a car accident?

At that age, I'd expect some pre-existing conditions that would be also impacting here. If a passenger hits the windshield, especially to the point of bulging the windshield (There is a layer of plastic between the glass. The glass can shatter with the plastic bulging. This is the last step before the passenger goes through the windshield.), I would expect, especially with the age of your passenger, some serious cuts in other parts of her body. Reasonable to expect some additional broken bones, and with the brittleness of her bones, highly probable.

If she's on any sort of blood thinner (likely), bleeding would be rather massive and a major concern at the scene of the accident and the blood lose would contribute to the unconsciousness.

Best of luck,

Jim Clark-Dawe

Hi Aruna- Jim is correct most elderly people are on blood thinners for one thing or another- if this woman hit her head she in all likleyhood had massive bleeding in her brain shown by a cat scan- nothing to operate on- I won't go into details on you, unless you want, but in my experience, this would not be a survivable injury.

If you still want your scenario, perhaps have her wearing her seatbelt. even with this she could suffer a serious head trauma that results in a subdural hematoma (blood clot on the brain). Then surgery would be needed and yes it would be likley that she does not wake up due to swelling and insult to the brain. Let me know if you need any more details, I would be happy to help

The blood issue isn't how much blood is strewn all over the place, from an EMT's point of view. It's the blood loss and the masking effect her blood pressure medicine is going to have on this. At some point, the lost of blood volume is going to send her blood pressure plummeting. Very, very suddenly.

This is a patient with two large bore IVs if her system will survive them, secured airway, defib pads in place, and three or four guys working in the back of the ambulance. It's an "Oh, shit" type call.

As an EMT, you know this patient is going to crash badly at some point. The question is whether you get her to the hospital before this happens. (In other words, can you make it someone else's problem.)

Trauma team is going to be activated by the EMTs en route. We'd be watching for leakage from ears, eyes, or nose as well as some other signs of internal bleeding. I'm with Sheadakota at doubting survivability of your patient. Eighty-year-old people with seat belts and airbags aren't great for surviving accidents. Again depending on underlying issues, it doesn't take a whole hell of a lot to kill them off.

Best of luck,

Jim Clark-Dawe

You could do anything (assuming that you don't mention what particular areas are injured). The more we know about brains the less we understand them.

People in their 80's have a tendency to "sundown" when faced with injuries or surgeries stressful enough to land them in the hospital for more than a couple of nights. The sleep deprivation combined with all the meds that they aren't used to can make them go a little or a lot crazy at night. It's weird when you see someone lucid during the day and totally bonkers at night with complex delusions and sometimes hallucinations. The more frail their health, the bigger the injury, the more likely that they will sundown. The best treatment I found was to discontinue all possible medications and by day 3 after withdrawing all the new meds, the sundowning would go away. Unfortunately many physicians mistake the sundowning for a psychotic episode and start drugging the people with more meds, particularly Haldol. If you want to read something scary, read the "Physician Desk Reference" insert for Haldol.

Bandages really only need to be kept on until the wound is dry and changed often enough that the dressing isn't soaked, since blood is a wonderful nutrient broth for bacteria. I'd expect that by day 2-3, the bandages could come off.

I don't know either, having never been to the UK.

Having a stave pierce someone's head is how they first started working out the different areas of the brain have different functions. A guy who was a railroad builder had a metal stake pierce his skull (think it was a frontal lobe but can't remember). He survived but his personality changed completely. He went from being a nice reliable family man, to an argumentative aggressive git.

Can't give you any more info than that, but where in the skull the injury occurs, and how deep, is crucial to how they are afterwards. If they are still essentially the same person in character, but physically disabled, that will be a particular area. Also have the suspicion, but no details, that speech loss and walking are different areas.

Aruna - IMO your situation works fine. True, it is possible to have something pierce the skull and walk away with no long term injuries - but it is perhaps even more likely to have a situation like you describe, with a serious brain injury and long term complications. (And that's IF the patient lives!) He'll probably be unconscious/on life support for at least a few weeks, if not longer. Then he'd probably be sent to inpatient rehab and, depending on how much he improves, he may even wind up in a nursing home.

Fwiw - this reminds me of a news story from a few years ago. Some kids were climbing a fence to get into a swimming pool. One of them was impaled on the fence. IIRC, he died pretty quickly.

I was curious myself - so googled. This website (from an organisation offering rehabilitation) seems to be a reasonable starting point.

www.neuroskills.com/brain-injury/brain-function.php

This is probably a good website for you to research.


http://www.myshepherdconnection.org/abi

one detail

With head injuries, doctor's might put the person in an induced coma, maybe 5 days or longer until any brain swelling subsides. I'm not a doctor, but a friend of the family is in this exact situation, and every is waiting until she wakes up . . .

Standard disclaimer, I'm not a medical professional, blah blah. I'm thinking of the "ABC's" of CPR - airway, breathing, circulation. I would imagine that the first thing he'd do would be to check those.

He'd splint any obviously broken bones, maybe put him on a crude backboard. Since he's in Guyana, I'm sure the doctor would be macgyver-ing quite a bit.

Blood loss would probably be a big issue. Does the patient have any significant lacerations other than the one on his head? Plus obviously he'd need a ton of support for the metal spike when they're cutting it - don't want it to move around if possible.