The real-life trauma of accidents resulting in blunt head trauma and gunshot wounds are not just seen in media dramas but in every community across the nation. The focus of care for such events is in large urban and small community emergency departments across the state of Kentucky.
“In general, young adult males are the category of patient that are most likely to be affected by blunt head trauma from things like car wrecks, falls or sports-related injuries,” said Dr. Roger Humphries, chair of the department of emergency medicine at University of Kentucky Hospital.
There is a wide range in the degrees of severity and the mechanisms of head injury, Humphries said. When diagnosing the extent of head trauma, the examining physician looks closely at the patient’s neurologic function.
“There is a wide range in the degrees of severity and the mechanisms of head injury.” –Dr. Roger Humphries
“We look to see if they are back to normal, able to do everything they could do before the trauma; if they have a period of amnesia; if they are confused; and if they have vomiting or other associated injuries such as a neck or spinal injury,” said Humphries. “We often observe patients for a period of time and do imaging studies like CT scans to look at the brain and skull.”
Some critical responses are used when evaluating patients with head trauma. “We do a physical exam, take a history and find out what events surrounded the injury,” Humphries said. It is necessary to know whether the patient fell off a ladder that was 12 feet in the air or simply tripped on his own feet and fell two to three feet to the ground.
According to The Brain Injury Guide, an initial emergency room evaluation is critical for persons with moderate to severe head trauma. This evaluation seeks to stabilize the person’s breathing, pulse and blood pressure; assess the severity of the brain injury; determine the risk of further deterioration and identify other potentially life-threatening injuries; and assess involvement of alcohol or illicit substances in the injury.
“There is a wide spectrum of head injury, from somebody that bumps his head and has a headache to having such a severe head injury that the person is no longer conscious and has bleeding on the brain, swelling or other problems that will take a long time to recover from,” Humphries said. “The patient can have symptoms for weeks afterwards.” These include headaches, dizziness and attention problems. Patients should follow up with their family doctor and take advantage of special resources such as a concussion clinic, if applicable.
Physicians cannot preach prevention enough. “Since we are getting into the outdoor times of life here, focus on wearing helmets when rollerblading, skateboarding and bicycling to reduce head injuries,” Humphries said. “It could take what would be a severe injury and make it moderate or what would be moderate and make it minor.”
UK Hospital conducts research on head injury and trauma. “We have active research sponsored by the National Institutes of Health on head trauma here at UK,” Humphries said. “We have the ability to offer eligible patients the chance to go in the studies that are looking for treatments that could reduce the effects of head trauma and give the patient a better chance of full recovery.”
Gunshot wounds are more common in larger cities with big populations, but they still occur in Lexington. “Unfortunately, we see a fair number of gunshot wounds,” said Humphries. “They are severe and often life-threatening and non-survivable.”
As with head trauma, there is a huge spectrum to the array of gunshot wounds. “There are wounds that are grazing injuries to the skull, which do not cause intracranial bleeding or injuries,” Humphries said. “Those are lucky situations, but any time a bullet get in through the skull, it causes massive damage.”
For both blunt head trauma and gunshot wounds, prevention comes down to playing it safe. “People can be responsible drivers, avoid drugs or alcohol, avoid driving when tired and not drive distracted with texting or cell phones,” said Humphries. Taking precautions can reduce the chance of motor-vehicle collisions.
The key to preventing gunshot wounds is to be careful with firearms. “Make sure firearms are kept in secure areas away from children and adolescents so there is no chance kids will get into anything,” said Humphries.
By Jamie Lober, Staff Writer