Traumatic Brain Damage

Published on: January 14, 2012

Less than 1 in 10 patients die from their combat-related injuries.

by Stephen Bilkis

News studies have documented a decrease in the killed:wounded ratio thanks to advances in medical science. Less than 1 in 10 patients die from their combat-related injuries. Even on the battlefield, there have been great medical innovations. Clinical improvements used to treat traumatic brain injury (TBI) include early decompressive craniectomy, neuro-critical care, cerebral angiography, transcranial Doppler, hypertonic saline, TBI clinical management guidelines, among other techniques.

All the new medical procedures have resulted in a greater survival rate for fighters injured in combat, according to authorities. This, however, leaves a great many with debilitating injuries, which means new procedures for rehabilitation must be developed.

The press reports the frequency of explosive blast traumatic brain injury (bTBI) as around 40-60% of deployed U.S. combatants. Another report estimates as many as 320,000 or 20% of all forces deployed suffer from some kind of TBI. There is little evidence to support these claims and a comprehensive study of bTBI has yet to occur.

Published on: January 8, 2012

Things become much more complex in a non-free field or enclosed area

by Stephen Bilkis

The type of explosion studied theoretically in the determination of the causes of explosive blast traumatic brain injury (bTBI) assumed an open field explosion. Things become much more complex in a non-free field or enclosed area, such as a building, doctors have learned.

In an enclosed space, the shockwaves can reflect from walls, ceilings, and other objects, creating a “complex wave field.” An explosive blast under such conditions creates an individual scenario that cannot accurately be predicted or replicated.

Hospitals have noted there has been the assumption that pressure, and not the shockwave, may cause bTBI, but such studies may not be valid. These studies suggest the pressure of the blast leads to failure of air-filled organs, such as the lungs and the bowels. Therefore, if this is true, lungs should be injured more often in explosions. Clinical experience shows this is not the case. The bowel is generally uninjured unless there is penetration from shrapnel. Brain injury was not studied and some believe interceptor body armor may protect those organs from the blast. There may even be other physical forces that play a role in explosive blast injury.

Published on: December 31, 2011

The symptoms of bTBI (explosive blast traumatic brain injury) can actually be very subtle

by Stephen Bilkis

The symptoms of bTBI (explosive blast traumatic brain injury) can actually be very subtle, doctors tell patients. Sometimes, there is no outward sign of brain injury until certain symptoms begin to arise, like headaches, vertigo, or short-term memory loss. Because of this, victims of bTBI should be evaluated by a physician or psychologist to determine how extensive their injuries might be, if any. Neurophysical evaluation should be a part of this examination. There are currently efforts to create neuropsychological tests that can be automated on laptop computer or are easy enough to be used to by first responders who may have less training.

Patients who may have PTSD (post-traumatic stress disorder) should see a combat stress team provider or a psychiatrist as soon as possible. It is very important to remember, doctors have learned, that bTBI and PTSD can have very similar symptoms and may occur alone or together in a patient. It may be difficult to tell them apart.

When TBI brain injury may be present in a patient, that person should be excused from all combat-related duties. The patient should be put on light duty until the symptoms are gone or until he or she is moved to a place where advanced neuroimaging, like MRI, may be used, and a more detailed evaluation can be used. Studies in Manhattan and Long Island have determined that it is vital for a patient suffering TBI, or who may be suffering from it, to be treated with the utmost care, so the condition does not become worse.

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 19, 2011

Things become much more complex in a non-free field or enclosed area, such as a building

by Stephen Bilkis

The type of explosion studied theoretically in the determination of the causes of explosive blast traumatic brain injury (bTBI) assumed an open field explosion. Things become much more complex in a non-free field or enclosed area, such as a building, doctors have learned.

In an enclosed space, the shockwaves can reflect from walls, ceilings, and other objects, creating a “complex wave field.” An explosive blast under such conditions creates an individual scenario that cannot accurately be predicted or replicated. Studies in Suffolk and Westchester counties have confirmed this.

Studies have noted there has been the assumption that pressure, and not the shockwave, may cause bTBI, but such studies may not be valid. These studies suggest the pressure of the blast leads to failure of air-filled organs, such as the lungs and the bowels. Therefore, if this is true, lungs should be injured more often in explosions. Clinical experience shows this is not the case. The bowel is generally uninjured unless there is penetration from shrapnel. Brain injury was not studied and some believe interceptor body armor may protect those organs from the blast. There may even be other physical forces that play a role in explosive blast injury.

Published on: December 11, 2011

Post-traumatic stress disorder (PTSD) is now a well-defined clinical syndrome

by Stephen Bilkis

Post-traumatic stress disorder (PTSD) is now a well-defined clinical syndrome, according to experts. The 2000 edition of the Diagnostic and Statistical Manual Disorders, Fourth Edition, Text Revision states that some patients who experience life-threatening events might well feel intense fear or helplessness which becomes PTSD.

Victims of PTSD suffer through a number of symptoms, which may include re-experiencing the traumatic event, avoidance of stimuli associated with the event, a loss of concentration, sudden anger or irritation, hypervigilance, and a heightened response to being startled. All of these can cause a detrimental effect on the victim to enjoy life.

Mild explosive blast traumatic brain injury (bTBI) has many of these symptoms in common with PTSD, including changes in sleep patterns and moods. There are some differences, however, doctors have learned. Headaches, for instance, are much more likely with TBI, while hypervigilance and the tendency to startle more easily is more common with PTSD.

Published on: November 21, 2011

The military also uses the same criteria to assess such injuries as civilians

by Stephen Bilkis

Physicians currently do not have many distinctions between explosive blast traumatic brain injury (bTBI), closed head traumatic brain injury (cTBI) and penetrative traumatic brain injury (pTBI). The military also uses the same criteria to assess such injuries as civilians.

A 1993 definition from the Mild Traumatic Brain Injury Committee of the American Congress of Rehabilitation Medicine of TBI apples to bTBI when an explosive blast causes loss of consciousness, amnesia, or loss of focus. The severity is determined by how long the altered mental state lasts. Less than 5 minutes is mild, though it can lead into difficulties like headaches, confusion, and amnesia, as well as a difficulty to concentrate, altered mood, problems sleeping, and general anxiety. These symptoms usually go within a few hours or days.

Authorities have discovered that even these mild cases could result in post-concussive syndrome which could happen days later. Government agencies and authorities in Manhattan and Long Island are currently developing guidelines to manage this condition, which seems to respond to simple reassurance and specific treatments like non-narcotic analgesics, anti-migraine medication to treat headaches, and anti-depressants. Just as with civilian cTBI, the problem might last only a few weeks, but it might well last a year or more in some cases.

Published on: November 10, 2011

Diagnosing a concussion or mild TBI (traumatic brain injury) can be difficult

by Stephen Bilkis

Diagnosing a concussion or mild TBI (traumatic brain injury) can be difficult, even to experienced physicians, especially on the battlefield, New York Brain Injury Lawyers 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. Hospitals in The Bronx and Brooklyn are aware of these circumstances.

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, New York Brain Injury Lawyers 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: November 3, 2011

Physicians currently do not have many distinctions between explosive blast traumatic brain injury (bTBI), closed head traumatic brain injury (cTBI) and penetrative traumatic brain injury (pTBI)

by Stephen Bilkis

Physicians currently do not have many distinctions between explosive blast traumatic brain injury (bTBI), closed head traumatic brain injury (cTBI) and penetrative traumatic brain injury (pTBI), according to New York Brain Injury Lawyers. The military also uses the same criteria to assess such injuries as civilians.

A 1993 definition from the Mild Traumatic Brain Injury Committee of the American Congress of Rehabilitation Medicine of TBI apples to bTBI when an explosive blast causes loss of consciousness, amnesia, or loss of focus. The severity is determined by how long the altered mental state lasts. Less than 5 minutes is mild, though it can lead into difficulties like headaches, confusion, and amnesia, as well as a difficulty to concentrate, altered mood, problems sleeping, and general anxiety. These symptoms usually go within a few hours or days.

Lawyers have discovered that even these mild cases could result in post-concussive syndrome which could happen days later. Government agencies are currently developing guidelines to manage this condition, which seems to respond to simple reassurance and specific treatments like non-narcotic analgesics, anti-migraine medication to treat headaches, and anti-depressants. Just as with civilian cTBI, the problem might last only a few weeks, but it might well last a year or more in some cases.

Published on: October 30, 2011

No one is certain what really causes primary explosive blast traumatic brain injury (bTBI)

by Stephen Bilkis

No one is certain what really causes primary explosive blast traumatic brain injury (bTBI), according to New York Brain Injury Lawyers. Clearly, the “cause” is the explosion and the mechanism by which it works is the interaction of explosive force upon the human body, but this does not medically explain everything that occurs.

There are primary and secondary injury mechanisms when it comes to trauma. Primary injury mechanisms can be attributed directly to the cause of the injury, like laceration from a cut. Secondary injuries are physiological responses, like bleeding or bruising. When it comes to bTBI, doctors in Staten Island and Westchester County have learned, there is probably more than one primary injury mechanism involved.

The blast produced by an explosive device travels through a medium like air or water in a wave of pressure. Basically, a great deal of energy is chemically produced. Mechanical, thermal, and electromagnetic energy is transferred into the surrounding medium, and into anyone who happens to be in the blast radius.