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<P>Well Dean, I think that you may have had one of two problems.</P>
<P>More than likely, this kid had some GHB on board. this may be correlated with his history, but without knowing what the circumstances of his trauma was, it would be hard to say from my point of view.</P>
<P>The other possibility is of axonal degeneration. There is no mention of head trauma with this kid. Although in my limited experience in a Melbourne Trauma Centre, diffuse axonal injury is a BAD BAD entity, with a really slow if not fatal prognosis.</P>
<P>Tox screens, depending on what youre looking for sometimes don't pick up GHB or derivatives, which might explain the negative tox.</P>
<P>I would be interested in learning what other, more experienced colleagues would think of this.....</P>
<P> </P>
<P>Mohan Kamalanathan</P>
<P><BR><FONT style="FONT-SIZE: 11px; FONT-FAMILY: tahoma,sans-serif">From: <I>"Bjorn, Pret" <pbjorn@emh.org></I><BR>Reply-To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>To: <I>"Trauma &amp; Critical Care mailing list" <trauma-list@trauma.org></I><BR>Subject: <I>RE: Odd head injury</I><BR>Date: <I>Fri, 1 Sep 2006 08:39:58 -0400</I><BR>>I'm late to the dance, but I have brought stupid questions.<BR>><BR>>What was his medical history? Was he on anything besides ethanol?<BR>>Anything regularly prescribed?<BR>><BR>>And what happened during the hour you were away? Was he given anything<BR>>for pain, anxiety, or nausea?<BR>><BR>>Sorry, but having once been the victim of a med error, I'd be curious if<BR>>someone missed a decimal
point on a dose somewhere.<BR>><BR>>All's well that ends well, in any event.<BR>><BR>>Pret Bjorn, RN<BR>>Bangor, ME USA<BR>><BR>><BR>><BR>>-----Original Message-----<BR>>From: trauma-list-bounces@trauma.org<BR>>[mailto:trauma-list-bounces@trauma.org] On Behalf Of Dean Lutrin<BR>>Sent: Thursday, August 31, 2006 7:44 PM<BR>>To: 'Trauma &amp; Critical Care mailing list'<BR>>Subject: Odd head injury<BR>><BR>>Dear Listmembers<BR>><BR>>I would like an opinion on a recent case I saw. Young male thrown off a<BR>>bridge - didn't get any more details. Came in slightly confused (GCS<BR>>14/15)<BR>>with a a fractured wrist and ankle. It was one of those nights in a<BR>>Johannesburg trauma unit and I had to run off to sort out another<BR>>patient<BR>>and I left my patient with one of the interns. I wasn't too
worried<BR>>about<BR>>him compared with the other patients I had to sort out. Came back to him<BR>>an<BR>>hour later and he was comatose. GCS 3/15. Intubated without drugs. CT<BR>>brain<BR>>normal. Nothing else on imaging aside from wrist and ankle. Ventilated<BR>>overnight with good spontaneous respiratory effort and reactive pupils.<BR>>GCS<BR>>still 2/10. Next day started waking up quite nicely. Extubated 36 hours<BR>>after initial injury with full recollection of everything up to arrival<BR>>at<BR>>hospital. Resources didn't allow me to CT again before extubation. Full<BR>>toxic screen negative, but patient was drunk.<BR>><BR>>Questions<BR>><BR>>1. was this just a concussion?<BR>>2. I have never seen a patient drop to 3/15 from 14/15 with a normal CT<BR>>and<BR>>then have a full recovery. Is it common?<BR>>3. Anything else could have caused it?<BR>><BR>>Thanks<BR>><BR>>Dean Lutrin<BR>>JHB, SA</P></DIV>
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