By Tedler D. Depaynos, MD
The children were playing in the neighborhood streets as usual when one of them, a little girl suddenly ran crossing the street. She might have noticed the incoming motorcycle because her playmates saw her try to stop but still the motorcycle hit her hard throwing her back to her playmates. She was rushed to the Emergency Room where she was given emergency treatment.
If not for the strong alcoholic breathe of the motorcycle driver it could be said that it was the fault of the little girl. The driver even became noisy with a loud voice at the hospital defending himself. Anyway, it was a police matter.
The little girl incurred many injuries but what was significant was her head injury.
In treating head injuries, the layers of the head are always taken into consideration. External to the bony skull is the scalp. The patient had a small bleeding laceration at her scalp but upon slight palpation there was an apparent little depression of the bony skull implying a depressed fracture. For simple laceration, emergency control of bleeding is just pressure and of course suturing eventually. If with just contusion and hematoma with no laceration, they are just observed for with time they will eventually subside.
Fractures of the skull may occur but again most of the time nothing is done especially if they are not exposed or open or not depressed compressing the brain. In this case since it was an open fracture, cleaning was a must. An emergency x-ray was then done to determine the degree of compression.
In many instances, skull fracture may be equated to the degree of head injury. This is not always true because in many instances, no fracture may be seen but the brain incurred severe injury. Fractures maybe seen in x-rays but brain injuries may not. They are determined clinically or by thorough physical examination of the attending physician. At present however, a CT Scan or MRI which could reveal injuries to both skull and brain are routinely taken.
The brain is in a closed space limited by the bony skull. Jarring then of the brain itself when the head is traumatized may result in injuries sometimes in both sides. The least serious is cerebral concussion where there is no anatomical injury. There is just a sudden physiologic cessation of function which would render the patient briefly unconscious. In an analogy, the current was cut off but the wires are still intact. This is what is experienced by boxers when they are knocked down unconscious but recovered quickly within 10 seconds. Depending on the force, some boxers would feel groggy for longer periods. As a rule, victims of cerebral concussions should not loss consciousness for more than 5 minutes. Nevertheless, these patients are admitted for at least 24 hours for observation.
In cerebral contusion, there is usually apparent loss of consciousness for more than 5 minutes and there is retrograde amnesia. These patients may not remember the events that occurred before they got unconscious. These are usually admitted for at least 72 hours for possible more serious injuries. There could be swelling of the brain tissues and destruction of brain cells. With time, the swelling will subside but if severe where the brain functions are compromised, supportive measures and medicines are administered to help the patient survive while waiting for the swelling to subside. In minor cases loss of function of certain brain cells may be taken over by the healthy ones and luckily, humans have millions of brain cells. In serious cases where massive brain cells are destroyed, resulting physical and sensory defects would be obvious and maybe permanent. Brain cells without oxygen even within 3 minutes would necrose.
Luckily, the patient recovered consciousness upon arrival at the hospital and began looking for her mama. She could remember the motorcycle hitting her but because of the severe pain she was feeling she was continuously crying. To the attending physicians, it was a good sign.
Her skull x-rays and CT Scan revealed a very minimal depression and a slight swelling of the brain but no bleeding. The attending physicians decided to just close the wound and then admitted her for observation and probable repeat CT Scan to monitor her recovery.**
