# How strong is a human skull? - GRAPHIC IMAGE WARNING



## Ops Paramedic (Apr 8, 2008)

The images below are from the CT-Scan performed on a patient that we treated some time ago, and are fairly visual in nature.  The thread is aimed at showing you that patients don’t just die and to ask some question which may touch on the ethical side of things.  



The patient’s injury was as result of an unfortunate self inflicted act.  A 1.5 ton front end loader’s ( TLB ) scoop, together with a down force of 1.5 ton came down onto the patient’s head.  Upon arrival at the scene, the question of: “Is the patient still alive?” was posed to the foreman by an ALS (Expecting to get the “No” reply).  He said that the patient was still alive...
When I arrived the other ALS had initiated treatment after ensuring the scene safety was intact.  At closer inspection, we could not believe that this patient was still alive.  It was obvious that the prognosis was zero, and you need not be a neurosurgeon to see that, as the there was copious amounts of grey matter protruding from the massive scull fractures.  We elected to intubate the patient and used 15mg Midazolam and 15mg Morphine IV to try and “induce” the patient who presented with trismus as well as a threatened airway resulting from fluid in the oropharynx.   All I can think of to compare the head immobilisation is:  Take a pumpkin drop it from the second floor and now try and immobilise it, its just moosh.   


Vitals signs of the patient of the patient was well within normal limits, and showed SpO2 of >98% pre and post intubation with a good respiratory efforts by the patient self.  The patient was taken to hospital for further management, and even tried to open his eyes in the emergency room.  The patient was admitted in the morning and subsequently passed away some 8 hours later.


When you look at the images, can you see what I mean about the prognosis??  As stupid as it sounds, would you have also treated the patient to this extend, or would you have maybe just packaged and transported lateral, as all the vitals were intact and make it someone else’s discission as to what to do ?  One of my main aims was to keep going with the necessary life support in order to possibly explore the avenue of organ donation (The family later elected not to give the patient up for organ donation).  Or how about keeping the patient “alive” purely for the family maybe to come and say good bye??  Your thoughts are...
Please note that these are my own thoughts and views of this particular call and may not necessarily reflect those of any of the other practitioners involved in treating this patient.


----------



## VinBin (Apr 8, 2008)

Truly fascinating stuff.


----------



## Meursault (Apr 8, 2008)

A family friend who owns an earthmoving business was looking at the arm of an excavator from the underside when a hydraulic line let go. The arm folded in and caught his head nutcracker-style. He got a trip to a trauma center and to be honest, I haven't seen him much since.
He did survive and with no grossly apparent neuro deficits, but I believe he has needed lots of PT, either as a consequence of his long hospital stay or brain damage from the initial injury.

It's amazing what's survivable, however briefly. Those are great images, btw. Can you justify imaging on an expectant patient just for educational/holy- :censored: -look-at-this value? 

No organ donation? Although I've never had to make a decision like that, I can't come up with any reason for not having a relative's organs donated except for religious/cultural taboo.


----------



## ErinCooley (Apr 8, 2008)

My daughters skull x-rays probably didnt look much differently from these yet I am thankful as hell that they did everything humanly possible to TRY to make her well.

We didnt donate organs.  She didnt require an autopsy but the coroner did have to tele-conference with the crime lab which seemed to take hours although it was probably only 45-60 minutes or so.  By that time, only tissue and eyeballs were donate-able.  I couldnt stand the thought of someone else having her eyes, they were beautiful.  We said that we would do tissue but after 4 or 5 calls between our cell phones and the tissue company who was having telephone problems, we finally said it was too much to deal with.


----------



## firetender (Apr 9, 2008)

Ethically, there's not much of a question here. In this case, only in triage would you deny care. You work with what you have and here, although not much, you have something. A decision based on future viability, fortunately, is not our call. Even in the case of triage action would be taken, it would just happen last.

One year I had five patients with gunshot wounds to the head--ALL of whom lived at least a week, so it's not a big surprise. I know lots of people who keep living even though their heads are not really attached.
(That's a joke, don't take it personally!)


----------



## paramedix (Apr 10, 2008)

I salute the paramedics and everyone involved in treating this gentleman. It is truly amazing to know that no matter how poor your prognosis is, there are still some people that would fight for your life and they dont even know you from a bar of soap.

Good on you guys!!!


----------



## TraumaHound725 (Apr 22, 2008)

paramedix said:


> I salute the paramedics and everyone involved in treating this gentleman. It is truly amazing to know that no matter how poor your prognosis is, there are still some people that would fight for your life and they dont even know you from a bar of soap.
> 
> Good on you guys!!!



Hi guys and gals, I"m new to this forum but not new to EMS.  I agree with the guys on here that talk about do everything you can until you have nothing left to do.  Other than in an MCI/triage situation, you have to do everything you know to do.  We are not to play God at all.  We are to use our knowledge/talents/abilities to the best that we know how and let fate figure the rest.  If it was you or your family  member, would you want us to walk up to that scene and say "He's breathin now, but he won't be soon, so we'll just wait for the "GREAT STABLE RHYTHM". 

Thanks to everyone who started this site as well as everyone who participates in it.  I hope to be an active member and be able to add something positive and also be able to walk with something positive.  "The best knowledge is the knowledge that you don't have enough knowledge!!"


----------



## mikeylikesit (Jun 4, 2008)

wow, that is something i hadn't seen yet. thanks.


----------

