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Entries in Head Trauma (2)

Tuesday
Jan172012

Safety on the Slopes

iStockphoto/Thinkstock(MORRISTOWN, N.J.) -- With skiing and snowboarding being two of the most popular sports in the U.S. and 9.9 million Americans taking part in these activities every year, seasoned skiers and boarders know that falling is an accepted part of the learning curve for beginners, and an inevitable event among even the most experienced in the sports.

Thankfully the risk of injury is low. The risk of being injured on the mountain is 1 in 500, the risk of sustaining a serious head injury is 1 in 5,000, and the risk of being killed on the mountain is 1 in 1 million. In this regard, skiing and snowboarding are safer sports than bike riding or swimming.

Nonetheless, head injuries can and will occur on the mountain, so it is important to take steps to prevent an injury and to know what to do if an injury occurs. The most common head injury occurs from falling and hitting the snow or ice, says Dr. Christopher Magovern, a cardiac surgeon at Morristown Medical Center in Morristown, N.J.  This is a particularly common injury for beginner skiers or boarders. Skiers usually strike the side of their heads, and boarders usually strike the back of their heads. Another, more dangerous injury occurs from colliding with a stationary object, commonly another skier or a tree.

In an effort to limit head injuries on the mountain, Dr. Magovern says your goals should be to: 1) prevent these sorts of falls in the first place, 2) decrease your risk of head injury by wearing a helmet, and 3) if you do sustain a head injury, be able to recognize the symptoms and know when to seek medical attention.

The first line of defense against head injuries is to ski responsibly -- that means always ski under control. When you stop, make sure you’re in a spot where others can see you, and stay away from trees, unless you really know what you’re doing -- they’re unforgiving.

The second line of defense is to wear a helmet. Can wearing a helmet make a difference? You bet it can. A helmet will reduce the risk of head injury, but it won’t make you invincible. What we’ve learned about wearing helmets is that it will decrease your risk of head injury by 20 percent to 50 percent -- it can mean the difference between a major head injury and a minor head injury, and it can mean the difference between a minor head injury and no injury at all.

But helmets do have limitations, Magovern notes. If you’re barreling down the mountain at 60 mph like Franz Klammer, injuries you sustain in a fall may overwhelm the protective capabilities of a helmet.
The average recreational ski or snowboarding helmet is designed to provide protection when skiing at speeds of less than 15 mph. Because it is common for skiers and boarders to reach speeds of 25-40 mph on some intermediate trails, recognize that, at these speeds, a helmet may not provide complete protection. For a helmet to provide proper protection at those speeds, it would have to be 7 inches thick, 20 inches wide, and weigh 10 pounds...and that’s simply unrealistic.

Magovern says the bottom line is that although helmets cannot provide ultimate protection for all falls, they will prevent or lessen the degree of head trauma for most falls -- and because there’s no good reason not to wear a helmet, just strap one on.

He adds that order to get the most protection from your helmet, it’s important that it fit properly. First of all, never use a bicycle helmet or skateboarding helmet; they are not designed for skiing or snowboarding. Your helmet should be snug, but not tight. Finally, ensure that your chinstrap is always fastened securely.

As recently as 2011, 46 states in this country had motorcycle helmet laws, 37 states had bicycle helmet laws, and not a single state had any law mandating the use of helmets on the slopes. Our European colleagues have been ahead of us in this regard -- in 2009, Austria mandated that all children less than 14 years old must wear helmets.

But things are changing; in April 2011, Gov. Chris Christie of New Jersey signed a bill that mandates that children less than 18 years old must wear helmets while skiing or snowboarding or their parents will face fines that range from $25-$50. Similar legislation is pending in New York.

Finally, the last line of defense against head injuries on the mountain is to be able to promptly recognize an injury when it occurs, so treatment is not delayed.

Copyright 2012 ABC News Radio

Thursday
Dec222011

Poised to Donate Organs, 21-Year-Old Emerges From Coma

iStockphoto/Thinkstock(PHOENIX) -- Sam Schmid, an Arizona college student believed to be brain dead and poised to be an organ donor, miraculously recovered just hours before doctors were considering taking him off life support.

Schmid, a junior and business major at the University of Arizona, was critically wounded in an Oct. 19 five-car accident in Tucson.

The 21-year-old's brain injuries were so severe that the local hospital could not treat him. He was airlifted to the Barrow Neurological Institute at St. Joseph's Medical Center in Phoenix, where specialists performed surgery for a life-threatening aneurysm.

As hospital officials began palliative care and broached the subject of organ donation with his family, Schmid began to respond, holding up two fingers on command. Today, he is walking with the aid of a walker, and his speech, although slow, has improved.

Doctors say he will likely have a complete recovery. He even hopes to get a day pass from the hospital to celebrate the holidays with his large extended family.

"Nobody could ever give me a better Christmas present than this -- ever, ever, ever," said his mother, Susan Regan, who is vice-president of the insurance company Lovitt-Touche.

"I tell everyone, if they want to call it a modern-day miracle, this is a miracle," said Regan, 59, and a Catholic. "I have friends who are atheists who have called me and said, 'I am going back to church.'"

Schmid's doctor, renowned neurosurgeon Dr. Robert Spetzler, agreed that his recovery was miraculous.

"I am dumbfounded with his incredible recovery in such a short time," said Spetzler. "His recovery was really remarkable considering the extent of his lethal injuries."

Hospital officials are crediting Spetzler with having a "hunch" that despite an initially dire prognosis, the young man would make it. But he said it was "reasonable" for others to consider withdrawing the patient from life support.

"It looked like all the odds were stacked against him," said Spetzler, who has performed more than 6,000 such surgeries and trained the doctor who operated on Congressman Gabrielle Giffords after she was shot at the beginning of this year.

During surgery, Spetzler clipped the balloonlike aneurysm in the blood vessel -- "as if I were patching a tire," a procedure that eventually worked.

For days Schmid didn't seem to be responding, but what puzzled his doctor was that he did not see fatal injuries on the MRI scan. So he decided to keep Schmid on life support longer.

"There was plenty wrong -- he had a hemorrhage, an aneurysm and a stroke from the part of the aneurysm," Spetzler said. "But he didn't have a blood clot in the most vital part of his brain, which we know he can't recover from. And he didn't have a massive stroke that would predict no chance of a useful existence."

So while the family was given a realistic picture of Schmid's poor chances for survival, Spetzler ordered one more MRI to see if the critical areas of the brain had turned dark, indicating brain death.

"If not, we would hang on and keep him on support," he said. "But I didn't want to give the family false hope."

Schmid's mother said no one "specifically" asked if her son would be a donor, but they "subtly talk to you about quality of life."

"At some point, I knew we had to make some sort of decision, and I kept praying," said Regan.

The MRI came back with encouraging news during the day and by evening Schmid "inexplicably" followed the doctors' commands, holding up two fingers.

"It was like fireworks all going off at the same time," said Spetzler.

Today, Schmid -- his speech clear and sounding upbeat -- told ABCNews.com, "I feel fine. I'm in a wheelchair, but I am getting lots of help."

He said he remembers nothing of the accident nor coming around after being in an induced coma. "It wasn't until I woke up in rehab," he said. "But they told me about afterwards."

Schmid was returning from coaching basketball at his former Catholic school when a van swerved into his lane. The Jeep in which he was riding went airborne, hit a light pole and landed on its side.

Schmid's left hand and both of his femurs broke and required surgery. But the worst were the traumatic head injuries, which were complex and nearly always fatal.

All those involved say the support that Schmid got from family and friends -- and especially the care at Barrow -- may have made the difference. His brother John, a 24-year-old IT specialist, took a leave of absence from his job in Chicago to be at his brother's bedside.

Family flew in from around the country, and Delta Chi fraternity brothers made regular visits, even creating a mural for their friend.

"It seems like we were being led down a path to plan for the worst and that things were not going to work out," said John Schmid. "The miracle, to put it bluntly, was that in a matter of seven days, we went from organ donation to rehab. What a roller coaster it was."

He said his brother's speech is slow, but he understands what others are saying. Sam Schmid's athleticism -- as a basketball coach and snowboard instructor -- probably helped, he said.

"Honestly, I am at a loss for words," said John Schmid. "I am just so proud of Sam. He's got a strong constitution and he's very determined. But it's been quite an eye-opener for me -- a real learning curve. You can't take anything for granted."

Sam Schmid's surgeon agrees.

"You get incredible highs when you save someone facing neurological devastation or death," said Spetzler. "That is counter-pointed by the incredible lows when you fail to help someone."

"In a way, his recovery was truly miraculous," he said. "It's a great Christmas story."

Ever the scientist, Spetzler wasn't willing to speculate what a comatose patient hears. But he admits, "There are so many things we don't understand about the brain and what happens at the time someone is near death."

"The whole family was at his side during the day and at night hovering over him, then to see there was a chance after being ready to let go," he said. "But I am very much a big believer that positive thoughts and positive energy in a room can only help."

Copyright 2011 ABC News Radio







ABC News Radio