Bronx

Published on: April 23, 2012

The current conflicts in Iraq and Afghanistan have led to a great many more serious injuries to United States service members

by Stephen Bilkis

The current conflicts in Iraq and Afghanistan have led to a great many more serious injuries to United States service members. One of the most prevalent and dangerous is explosive blast traumatic brain injury (TBI). Lawyers have been studying the rising trend.

There have been a number of military medical treatments for blast TBI which have been a success in the war theater, such as decompressive craniectomy, cerebral angiography, transcranial Doppler, hypertonic resuscitation fluids, and others. There has been similar progress stateside in neurosurgery, neuro-critical care, and rehabilitation for patients suffering injuries caused by blast TBI.

As they continue to treat these injuries, military physicians in The Bronx and Brooklyn have been able to clinically categorize many types of blast TBI, according to studies. One of these important discoveries is the development of psuedoaneurysms and vasospasm in severe blast TBI victims, which can cause delayed decompensation. Another is that mild blast TBI often has very similar clinical features to post-traumatic stress disorder (PTSD). Some physicians have conclude that the injuries explosive trauma causes to the nervous system might be more complex than might appear at first examination.

Published on: April 21, 2012

Penetrative TBI involves the penetration of a foreign object through the bones of the skull

by Stephen Bilkis

Lawyers have learned of a new classification for traumatic brain injury (TBI), known as explosive blast traumatic brain injury (bTBI). Previously, physicians divided TBI into two categories, penetrating traumatic brain injury (pTBI) and closed head traumatic brain injury (cTBI). Blast TBI is similar, but has some aspects that are all its own.

Penetrative TBI involves the penetration of a foreign object through the bones of the skull and into the brain parenchyma. This physically disrupts neurons, glia, and fiber tracts, which is made worse by ischemia and hemorrhage. Victims of this type of injury show signs of impaired consciousness and neurological difficulties associated with the parenchyma injured by the intrusion of the foreign object. An object penetrating at high velocity, like a bullet, will cause a great deal more damage, due to cavitation of brain tissue. There will be a breach in the skull where the object entered, and possibly another at the point of exit. pTBI is often easy to spot.

Closed head traumatic brain injury, is sometimes more difficult to spot. The brain moving inside the skull and deformation of the brain can cause injury to the brain parenchyma, blood vessels, and fiber tracts.

Published on: March 27, 2012

Severe facial trauma can prevent reliable neurological examination

by Stephen Bilkis

Sometimes the extent of moderate or severe damage caused by bTBI (explosive blast traumatic brain injury)is difficult to determine at first, doctors have told specialists. Severe facial trauma can prevent reliable neurological examination, especially when it comes to examining the pupils for reaction. Specialized tools are often necessary to even make triage decisions that could save lives.

The chaos of war only compounds the difficulty in making decisions when it comes to severe injury. When a doctor or other medical professional is used to medical centers in the United States, where there are adequate resources and help in the form of other professionals near at hand, it can be very difficult to work on a battlefield where everything is in short supply, but the number of patients is much greater.

Difficult decisions have to be made in such environments, experts have learned. It isn’t uncommon for a great number of severely injured patients to arrive at the same time. Efficient triage is essential for the best use of limited resources. There may be few health care providers, no operating rooms or CT scanners, and not many blood products to go around. It may even be impossible to evacuate patients to a better facility. The whole idea behind triage is take resources that may not be adequate and stretch them out to their best possible use to help the largest number of patients. They must be stabilized and their lives preserved until they can be evacuated into a better circumstance.

Published on: March 18, 2012

Care for victims of traumatic brain injury (TBI) starts on the battlefield, according to “Guidelines for Field Management of Combat-Related Head Trauma”

by Stephen Bilkis

Care for victims of traumatic brain injury (TBI) starts on the battlefield, according to “Guidelines for Field Management of Combat-Related Head Trauma”, doctors have learned. The combat medic works hard to prevent further harm from coming to the victim. The basics, such as the ABCs of airway, breathing, and circulation are tended to before work on the actual injury begins.

Once the patient is stabilized, the severity of the brain injury is determined, which helps form the basis of triage decisions. Someone who is less injured can be evacuated to a better facility than a field hospital. Some of these need to be moved by helicopter or some other expeditious manner. A blast from something like an improvised explosive device (IED) often results in multiple injuries, which need to be managed all at once.

The combat support hospitals in the Bronx and Brooklyn are the places for a more detailed assessment of injuries. When it comes to blast trauma, neuroimaging with CT scans should be done as soon as possible. It is important to identify things like intracranial hemorrhage, skull fractures, or cerebral edemas before they develop into something worse. Often it is necessary to perform emergency neurosurgery, studies have discovered.

Published on: February 27, 2012

Explosive blast traumatic brain injury (bTBI) can be a complicated thing

by Stephen Bilkis

Explosive blast traumatic brain injury(bTBI) can be a complicated thing, doctors have learned. The Centers for Disease Control and Prevention have determined secondary, tertiary, and even quaternary effects that may contribute to a particular patient’s condition.

The primary injury comes from the forces created by the explosion itself. Secondary injury might occur due to matter thrown by the explosion, like fragments from the weapon itself, or debris in the immediate environment. Tertiary injury occurs when the victim is thrown by the blast to strike a wall or the ground. Finally, quaternary injuries may occur from factors not included in the first three, like burns or inhalation of toxic fumes.

Experts have seen that the injuries can cause a number of symptoms. It might be as mild as a brief period of confusion – or it may lead to a coma. Severe bTBI commonly leads to diffuse cerebral edema and hyperemia, developing rapidly, within an hour after the initial blast injury. This type of injury seems to be much more common with blasts, as opposed to other forms of traumatic brain injury, and this type of injury has lead to military neurosurgeons performing more decompressive craniectomies more often than they would for penetrative traumatic brain injury (pTBI) or closed head traumatic brain injury (cTBI).

Published on: February 10, 2012

UFC Fighter Brian Foster Suffers Brain Hemorrhage

by Stephen Bilkis

Welterweight Brian Foster suffered a brain hemorrhagewhich results in him being out of his UFC 129 fight against Sean Pierson. The 27-year-old fighter posted the announcement two weeks ago on his Twitter account.

The Ontario Athletic Commission commissioned an MRI sixty days prior to the bout according to a friend. The test revealed a damaged blood vessel. Foster believes the injury took place during a hard sparring session he had before the test.

“I was dealing with a really good boxer and he caught me with a left hook that rocked me a little bit,” Foster said. “I hadn’t been rocked like that very often. I’ve never been knocked down. My record says I’ve been knocked out before but I was not unconscious in that fight.

Published on: February 5, 2012

Negligent Hospital Pays $5 Million Settlement

by Stephen Bilkis

A hospital found negligent was forced to pay out a birth injury settlement in the amount of $5 million to a 30-year-old woman whose child suffered severe birth injuries. The injuries were a direct result of medical malpractice.

A study reports that medical records submitted to the court showed that the plaintiff’s medical history illustrated no dire warning – i.e. nothing to be concerned about. The woman had progressed through her first pregnancy normally.

However, the plaintiff’s midwife reported that the 30-year-old was admitted into the hospital in premature labor with a 2cm-dialated cervix. An external fetal monitor was placed on her abdomen.

Published on: January 27, 2012

In the war theater, the primary caregivers are often medics

by Stephen Bilkis

Diagnosing a concussion or mild TBI (traumatic brain injury) can be difficult, even to experienced physicians, especially on the battlefield, researchers have been told. Yet, that does not diminish the importance of diagnosing such an injury as soon as possible so the appropriate medical care can be given as soon as possible. If it isn’t, the warfighter may be return to duty at impaired status and the condition could even worsen over time.

In the war theater, the primary caregivers are often medics, who are not as extensively trained as physicians. They may not be able to recognize such subtle injuries as the ones caused by mild TBI. Often there are no cuts or bruises with these injuries. In fact, the patient may not even know he or she has sustained an injury. Others may hide evidence of an injury to remain with their unit.

It is important that medics and other medical providers need to watch out for bTBI (explosive blast traumatic injury) after any soldier has been in close proximity to an explosion, experts have discovered. The patient may even need to be referred to another strata of care, like a neurologist, neurosurgeon, or emergency medical physician.

Published on: December 21, 2011

The chaos of war only compounds the difficulty in making decisions

by Stephen Bilkis

Sometimes the extent of moderate or severe damage caused by bTBI (explosive blast traumatic brain injury) is difficult to determine at first, doctors have told reporters. Severe facial trauma can prevent reliable neurological examination, especially when it comes to examining the pupils for reaction. Specialized tools are often necessary to even make triage decisions that could save lives.

The chaos of war only compounds the difficulty in making decisions when it comes to severe injury. When a doctor or other medical professional is used to medical centers in the United States, where there are adequate resources and help in the form of other professionals near at hand, it can be very difficult to work on a battlefield where everything is in short supply, but the number of patients is much greater.

Difficult decisions have to be made in such environments, officers have learned. It isn’t uncommon for a great number of severely injured patients to arrive at the same time. Efficient triage is essential for the best use of limited resources. There may be few health care providers, no operating rooms or CT scanners, and not many blood products to go around. It may even be impossible to evacuate patients to a better facility. The whole idea behind triage is take resources that may not be adequate and stretch them out to their best possible use to help the largest number of patients with brain injuries. They must be stabilized and their lives preserved until they can be evacuated into a better circumstance.

Published on: December 17, 2011

Driver behavior is naturally an important component in preventing injuries of any kind

by Stephen Bilkis

Driver behavior is naturally an important component in preventing injuries of any kind, including head injuries, experts note. The threat of legislative penalties does a great deal to influence risk-taking behavior. For instance, laws making the use of seatbelts mandatory increases the use of seatbelts, which decreases the rate of injury dramatically.

No matter where it is employed, the enactment of seatbelt laws tend to reduce the incidence of vehicle accident related head injury. Studies all over the United States, as well as some in European countries, confirm this time and again.

There is still a problem, with some cars, with the steering wheel causing severe brain injury in accidents, even when seatbelts are employed. The use of driver’s side airbags reduce even these injuries. Studies in The Bronx and Brooklyn say, however, that an airbag should always be used in conjunction with a seatbelt, not as a replacement for one.