Hey all, just got a few questions on head injuries. Now, im just wondering what actually causes the nausea and vomiting after a concussion? I thought it was swelling/pressure around one of the cranial nerves. Second, what is the best way identify what region the injury is located besides a isolated hematoma? Monitoring ETCO2, what do we wanna pinpoint on?
Isolated Head injuries
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paramagician
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I'm curious; why are you trying to figure out what portion of the brain is injured? How is it going to change your treatment of a patient with a head injury?
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I'm curious; why are you questioning someone's desire to increase their knowledge? How is it going be detrimental to his/her patient?
I would like to add to the OPs post; Can someone recommend a good neuro book you've used? Neuropathology has considerably spiked my interest as of late.
bigbaldguy
Former medic seven years 911 service in houston
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That's an excellent question I was wondering the same thing a few days ago.
Vomiting center is in chemoreceptor trigger zone in the fourth ventricle. Stimulating this area will cause the chain reaction that leads to vomiting. This can be stimulated by many, many means. This is the short answer of course. I'm sure someone will come along with the time (and desire) to layout the long drawn out version.
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zmedic
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This is a great neuroanatomy book, some pathology but not a pure pathophys book.
http://search.barnesandnoble.com/Ne...natomy Through Clinical Cases-_-9780878930609
http://search.barnesandnoble.com/Ne...natomy Through Clinical Cases-_-9780878930609
Thats actually one of the main neuro books I used in med school so I can highly recommend it. Certainly is detailed so not a just sit a glance at type of text but it's pretty all inclusive.
While I've used the micro made ridiculously Simple, I haven't read the neuro one in the series but here it is:
http://www.amazon.com/Clinical-Neuroanatomy-Made-Ridiculously-Simple/dp/0940780925
If you're looking for a basic review in a light reading style then that may be an option.
In this same category High Yield Neuroanatomy or BRS Neuroanatomy are both excellent. Really any of the BRS books are great for basic review/light reading.
For slightly more in-depth I liked the text by Nolte that was our required text in neuroscience.
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Not all brain injuries are the same and treatments can indeed differ. Wouldn't it be nice to distinguish between a concussion and a bleed? Do you treat both the same, cause I sure don't. If I did we would have sent at least 20 athletes to get unnecessary CT scans in the last four months alone.
zmedic
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And how exactly does your prehospital treatment change? There are rules we use in the ER to decide if we are going to CT someone. But spending time on scene trying to localize where the injury is doesn't make sense. If you can recognize important neuro signs like decorticate v decerebrate posturing, great. Good info to pass along. But I really doubt people are doing localization on scene.
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Not everyone with a head injury needs to go the ER, nor do they all need a neuro consult. If the only treatment algorithm is "take to hospital," something is being done wrong. Concussions by themselves are not significant enough to warrant hospitalization, at least in the Sports Medicine world. We can assess a player immediately and determine if he is suffering from a concussion or something more serious. If it is more serious, EMS is activated and the player will be transported to ER. If the player is only suffering the effects of a concussion he will enter our own treatment program that does not involve the hospital unless symptoms worsen. He will also not play or practice for at least a week.
zmedic
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The OP was talking about identifying the region of the brain that is injured. I'd argue if there are any focal neuro deficits you need to go to the ER. Actually, i'd say if there are any deficits at all you must go to the ER. So if you are trying to figure out where the person's brain in injured, they are going to the ER. Being able to say "oh, this is broca's area isn't going to change much in EMS.
If you are interested in learning more neuro, I say go for it. But it shouldn't be keeping most EMS people up at night worrying about not know it.
If you are interested in learning more neuro, I say go for it. But it shouldn't be keeping most EMS people up at night worrying about not know it.
You see, thats the problem. Any head injury that causes a sudden intermittant loss of consciousness, sycope, a brief seizure, so forth ops a trip to the er, or truama center if the er doesnt have CT capabilites. increase of age in the patient increases risks. The main reason for this post is to gain addional knowledge like all things posted here. It is very important not to delay treatment taking them to a er then having a ER doc say, "oh well this patient needs to go to a truama center, or better yet, they need a CT." Wasted time, wasted treatemnt. I know advanced assessment to pinpoint if its a bleed, region of the brain that could be affected, through confusion, combative nature, focal deficits in cognitive, concentration procedures, GCS. Really all my quesion was, was what causes the patient to vomit after a head injury and more advanced cranial nerve assessments.