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The Scenario:
As a member of his college's downhill ski team, Craig was a great competitor. When he wasn't actually on the mountain skiing, he was training, building his strength, and getting ready for the next competition. But after graduation he found that recreational skiing just didn't give him the kicks he once enjoyed, so he decided to take up snowboarding. A shredder at last! After the requisite first days of having his body slammed into the mountain in all kinds of awkward, painful ways, he began to get the hang of it. Building confidence, he began to tackle the intermediate slopes and even some of the easier expert runs.
Early on the morning of his third day boarding, he was cruising along, taking a warm-up run. He was carving a gentle curve across the snow, when a five year old, zipping along doing the snowplow, suddenly cut him off. In an effort not to hit the child, he lost control of the board and flew off the trail, landing hard on his shoulder and whacking his head on a patch of ice. The child skied on, unaware of Craig's wipeout.
Dazed for a couple of minutes, and quite sore, Craig managed to get back on the board. Everything still worked (both board and body), and he finished his run. Deciding he needed a break, and with quite a severe headache, he took off the board and headed toward the base hut.
Observers at the mountain later said he collapsed just before he made it to the hut.
Questions:
Answer:
This is another true emergency. Here's the response from this week's winner, one of many correct answers:
"He bumped his head against a patch of ice. The biggest danger is a subtle bleeding inside his skull. If he has epidural or subdural bleeding he might even die. He collapsed of increasing intracranial pressure. The interval between the accident and collapse is often called 'lucidum intervallum'. In this period he can do anything as if nothing had happened ... I would call an ambulance car and ask for a computer tomography or MRI examination to see whether he has intracranial bleeding."
Abrupt loss of consciousness minutes after a head injury is very worrisome since as noted above it may indicate a hemorrhage within the skull. One type of hemorrhage, or bleed, is called an epidural. This occurs when a high pressured artery between the skull bone and the dura (the protective lining covering the brain) is torn. Blood begins to accumulate under pressure, and because the skull cannot expand, the brain is compressed. This is a life-threatening emergency. Under sufficient pressure, the brain will herniate through the opening at the base of the skull (where the spinal cord exits) causing death. The only treatment is to immediately drill a burr hole in the skull to allow drainage of the accumulated blood.
There is only so much you can do at the ski slope. Virtually everyone recognized that this was a potentially serious injury, and suggested getting an ambulance or helicopter immediately. Minutes count, and the sooner he can be taken to a hospital, the better. There are other diagnoses to think about, however. Many people thought about an injury to the spine -- a good thought, and one that would necessitate immobilizing the spine before moving him. Others suggested a simple concussion, wherein there may be loss of consciousness or confusion as a result of a good bang to the head, but where there is no bleeding. An emergency CAT scan will sort that out. Keeping a watch on his breathing and pulse are also a good idea. If you or somebody nearby knows CPR, this is a good time to be ready.
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