Archives For trauma

Guidelines for treating brain trauma

Dr. Jamshid Ghajar, is a well-known neurosurgeon, president of the Brain Trauma Foundation, chief of Neurosurgery at New York’s Jamaica Hospital-Cornell trauma center and a practicing neurosurgeon at New York Hospital. In 1996, he saved the life of a woman who was savagely beaten in Manhattan’s Central Park using innovative neurosurgical procedures.

Interview on Treating Brain Trauma

I was interested in this interview because IF you or a loved one were ever in an accident and need medical attention you would have some understanding of what to ask about the hospital’s protocol.

This interview is from Nova and unfortunately I can’t get the audio to play on my Mac.

Nova: What’s a typical kind of place if you had a severe head injury and you ended up—what would they do?

I would say a sort of typical not very active trauma center would—you’d be put on a respirator. You would be given—you’d be hyperventilated, which means that they’d put you on the respirator and breathe you very rapidly. You would not have your brain pressure monitored. You may be given steroids, which have been shown to have no effect on head injury in terms of outcome. And you’d be given some drugs that cause you to lose a lot of fluids. And eventually you would lose so much fluids that your blood pressure would drop and you would die. More than half the people coming in that situation would die, and the rest of them would end up with significant disability.

Human Brain Synaptic GaspDr. Jamshid Ghajar did a survey with the Brain Trauma Foundation of 260 trauma centers throughout the United States that took care of severe head injury. And he asked them very basic questions like:

How many head injury patients do you see a month?

Do you monitor the pressure in the brain?

Do you treat brain swelling and so on?

And we found indeed there was a great deal of variability. And some of the treatments that were being used were—frankly, there was no scientific evidence supporting them, and in some cases could be deleterious.

So based on this and from my colleagues and my personal experience in talking around the country, we decided to develop guidelines.

What are the key parts of the guidelines?

Probably the key part is monitoring the brain pressure—the key part in treating patients with severe-head injury and trying to prevent the second injury—the first injury is the accident. You’re trying to prevent the second big injury. You’ve got a small piece of brain that’s been bruised and now this is being propagating. It’s going throughout the whole brain. You’re trying to prevent that from occurring. And the way to do that is diagnosis, which is monitoring the brain pressure, putting a tube in the brain and monitoring the pressure. Once you do that you get a number. Once you get that number you know how swollen the brain is, and then you do other things to try to prevent the brain from swelling even more.

How do you prevent the brain from swelling anymore? 

You have this fluid that the brain makes every single day, and it floats in it – the spinal fluid. The thing is to put this tube into the middle of the brain where the spinal fluid is made so that you can measure the pressure in the brain and if the pressure gets too high, you can just drain some of this fluid and relieve the swelling. We always put the tube into the front part of the brain.

One of the main problems is not having an adequate blood pressure in the brain.

Now, what does that mean? It means the brain is swollen.

It’s very high pressure, and you’ve got to get blood and oxygen into it. And if the blood pressure drops, you’re not going to get your oxygen and blood into the brain. The brain’s going to suffer even more injury.

It sounds like treating the brain injury is more work? 

There is more work on the part of the medical personnel.

There is more work.

It’s a lot easier just to put the patient on the ventilator and then turn up the rate and then give them some drugs and come back next week and see how they’re doing. They’re lying there in a coma. They’re not screaming out for help. They’re not saying, “I’m in pain.” And so it would be quite easy to say, “Well, they have half a foot in the grave, why do anything else?”

“That’s the real issue.

I think if these patients were awake and saying, “Listen do something for me,” we’d be doing a lot more for them.

But because they’re in a coma and they cannot speak for themselves, we’re treating them the way they are now.”

Resistance from Doctor’s.

Dr. Jamshid Ghajar was asked if he got any resistance when sharing the guidelines. His answer:

“I think when I talk privately to doctors, they say, “Yeah, I know about the evidence, but I still do what I do.” And there’s no rationale for it. And, you know, scientific data can be disputed. You can be controversial. In fact, the way we did the guidelines to show some evidence is stronger than others. But currently this is the best evidence we have.

Now, you can say, “I don’t believe the evidence. I believe the way I practice.” Well, that’s just not good science. And I don’t think the public wants to be exposed to this kind of variability.”

He continued, “here are a lot of young people, children, especially, who are dying unnecessarily. These kids could live and have a very good quality of life, and they’re dying.

I see it, the way they’re being treated. Kids more than adults are not having their brain pressure monitored and are being severely hyperventilated, having their blood pressure drop and so on. Kids can make a very good recovery, even better than adults. And what’s driving me is that there are deaths occurring every ten minutes as we’re talking. That a potentially salvageable patient that can go on and have a very good quality of life. We’re not talking about an 80-year-old or a 90-year-old with a stroke. We’re talking about a 15-year-old, a 14-year-old. Somebody who’s got the rest of their lives in front of them.”

Scientific Research Studies

Concussion Guidelines

Marked improvement in trauma centers when guidelines are followed. PDF

The entire interview with Dr. Jamshid Ghajar on Nova can be read here.

Ok, so what can we learn from this interview?

  1. There are guidelines and in many cases they are not being used.
  2. Many patients could have a good quality of life if they were treated.
  3. It is important to talk to your local hospital and find out what protocols they are using in the event you or a loved one has a brain injury caused by trauma.
  4. The fluid can be drained off the brain.
  5. That treating brain injuries is more work for the medical personnel.
  6. That fewer people would be pronounced “brain dead” if they were treated and not allowed to just lay there pumped full of drugs.
  7. That the secondary injury is “brain death” not the accident itself.

Flickr photo credit 

At least this is what I learned from the interview with Dr. Jamshid Ghajar, what did you learn?

I Hate October…

October 13, 2013 — Leave a comment

I Hate October

The kids and Mike and I 1998It came on suddenly, the month of October that is. I noticed it first in my lethargy, the strain of getting out to do anything. I noticed it next in my surviving children….tears and great sadness hitting them each at different times.

Jamie was in his car wreck on October 14th, 2011…two years ago tomorrow. I was driving in my car on my way to Nashville when I received the call. It was going to be a great time, as it was Presley Ann’s 1st birthday!

Two years later…tomorrow I am heading to Nashville again, only this time I am flying. Presley will be three years old.

Grieving A Child

The death of a child is unnatural…you are not prepared for it. The unnaturalness effects everyone in your family including the children left. They lost their brother. Their world…our world turned upside down. Then their niece, and 4 months ago their daddy.

Someone said to one of my children the other day, “you need you to get out, you will make more memories.”

Don’t they understand WE don’t want to make new memories?

We were a family of 7 at one time, and now down to five. Those who have lost a spouse or a child will understand that statement, those who haven’t will think we are all depressed.

No, we’re not depressed…it is called grief.

A Journey

Grief is a journey…not one we thought about or planned for. Who does?

Elizabeth Kubler- Ross wrote a book on the stages of grief. I can tell you from our experience’s the stages don’t follow a simple neat pattern….denial, isolation,anger, bargaining, depression and someday acceptance.

We are a close family…we fight…we make up and we are “loud.” Faith in God was a high priority in our home. One of my children, Matthew said one day to a friend, “we are a lot like the Osbourne’s only Christian.” I cringed at the time, but now I can laugh about it.

Christa, my daughter constantly says, “the house is too quiet.”

Becoming a mother was the most important thing I have done in my life. My children were my greatest source of joy and their hurts became my deepest sorrow. Now I am stumped I don’t know how to encourage them and see them through their grief, when I too am suffering.

C.S Lewis said in his book, A Grief Observed, that he never knew “grief could feel so much like fear.” He goes on to say, he is not afraid but it feels like fear…the fluttering of the stomach, the yawning,the swallowing and the restlessness. But my experience is different, I live in the fear. Not of dying…I’m not afraid to die.

I live in fear of something else happening to one of my children and having to bury another one. The thought of going through another trauma is unbearable. When my husband died in June, I lost my sounding board…the only person on earth that understood what that fear felt like. Mike the one who would hold me at night and without words absorb my pain and I his pain.

We and by that I mean my children and I were just “starting” to be able to function again, when Mike passed away. “No, I don’t want to go through this again, I don’t want to feel this way again, it is too soon, my heart cried out.”

But we did and do.

Grief is a human condition, it doesn’t matter if you are Christian or not, religious or not. When you love greatly you grieve when those you love leave.  The difference for us is that we grieve with hope knowing we will see them again.

1 Thessalonians 4:13-18

13 But we do not want you to be uninformed, brothers, about those who are asleep, that you may not grieve as others do who have no hope. 14 For since we believe that Jesus died and rose again, even so, through Jesus, God will bring with him those who have fallen asleep. 15 For this we declare to you by a word from the Lord, that we who are alive, who are left until the coming of the Lord, will not precede those who have fallen asleep. 16 For the Lord himself will descend from heaven with a cry of command, with the voice of an archangel, and with the sound of the trumpet of God. And the dead in Christ will rise first. 17 Then we who are alive, who are left, will be caught up together with them in the clouds to meet the Lord in the air, and so we will always be with the Lord.18 Therefore encourage one another with these words.


Norman Wright said in his book, Experiencing Grief, that it typically takes two years to recover from the natural death of a loved one, but if it was sudden it can take many more.

We have been ironically encouraged this week to hear from friends and family that lived with us through the trauma of being at Vanderbilt with Jamie. We know that they understand and are experiencing the same emotions of sadness we are.

I am leaving for Nashville tomorrow. It will be good to be altogether with those friends, and Christa decided she is driving down too.

I am going up to the 10th floor, the Trauma Unit at Vanderbilt and sit there in the family waiting area. It’s time to face those emotions and write about them down. My editor has been wanting me to dig deeper for my emotions, that should do it.