Health Sciences and Medicine: Symptoms Experienced During Severe Brain Damage - Essay Example

?Health Sciences and Medicine Order No. 603178 Introduction Head injury in children is an area of great concern for medical practitioners worldwide. Children engage in so many activities and hence are quite prone to head injuries which could be minor or major as the case may be. Head injuries range from a small bump on the head to Traumatic Brain Injury (TBI) which involves serious injury to the brain. In such critical cases of severe brain damage in children it may result in non -reversible damage to the brain because it involves heavy bleeding that directly affects the brain. To clearly understand the extent of damage, we need to examine the various symptoms that surface. Children experience many symptoms by which we could understand if the damage is minor or major. In this essay we would try to make an investigation of the different symptoms experienced during severe brain damage with particular reference to vomiting as one of the symptoms. There are two types of head injuries which are discussed below in order for us to understand when or why vomiting takes place. Background of the Study: Types of Head Injuries The brain is a soft jelly- like tissue that is surrounded by cerebrospinal fluid within the protective cranium. Though this fluid’s protective value is quite limited, yet it acts as a shock absorber. Since the skull acts as a protective shield for the delicate tissues of the brain, most of these injuries turn out to be minor ones. When the brain injury is a minor one, the symptoms usually disappear on their own. However, when children experience a critical head injury, it is crucial to render preliminary first- aid and rush the child to the hospital immediately. (Heegaard WG, 2009) Head injury symptoms include wounds and bruises, altered consciousness, nausea and vomiting. One of the most common types of traumatic brain injuries is concussion which involves the brain being severely shaken. Contusion is also a head injury which involves the bruising of the brain. Other head injuries include scalp wounds and skull fractures. (Atabaki, 2007) Head Injuries can be classified into two groups – 1) Closed head injury: when the skull receives a hard blow but does not get broken then it is said to be a closed head injury. 2) Open head injury: when the skull is severely injured and gets fractured and enters the brain tissues, then it is said to be an open head injury. Such an injury can occur when moving at high speeds such as in an accident or by a gunshot to the head. Symptoms of Severe Brain Damage Symptoms related to severe brain damage occurs according to the level of damage to the brain. Most people believe that vomiting takes place when children experience severe brain damage, while others believe that vomiting cannot be considered as a reliable symptom. Other symptoms besides vomiting include chronic headaches, memory loss, seizures, loss of consciousness sometimes leading to coma or paralysis, slurred speech, blurred vision, confused state, drop in blood pressure and other speech, vision and language problems. Among these symptoms, the symptom that will be discussed in detail would be vomiting in relation to severe head injury in children. Causes of Head Injury in Children Some of the common causes of head injuries occur due to automobile accidents, skating, pedestrian- car accidents, falling from heights, missiles and other non- accidental trauma such as child abuse. (Gedeit Rainer, 2001) These head injuries may be mild, moderate or severe depending upon the extent of brain damage. In a mild TBI, the child may experience a loss of consciousness for a very brief period of few seconds or minutes. There may also be headaches, nausea, temporary memory loss and behavioral and mood changes. However, if the TBI is moderate to severe. in addition to all the symptoms mentioned above, there could also be dilation of pupils, repeated vomiting, numbness of the limbs, loss of coordination, seizures and agitation. Vomiting takes place for many different reasons and in the case of head injury vomiting occurs due to the intracranial pressure brought about by the impact. (Tintinalli, Judith E. 2010) If the vomiting is profuse, it may alter the electrolyte levels and dehydrate the body. Immediate action should be taken during recurrent vomiting as it is an indicator of severe head injury. (Tintinalli, Judith E. 2010) Literature review (Fiona Brown et al., 2000) conducted a study involving 463 children who had a head injury. The study found that skull fracture did not increase when there was post- traumatic vomiting (PTV) In trying to determine the role of vomiting after a head injury, an investigation of other related factors was carried out such as family history of migraine and vomiting, site of impact, the presence of haematoma of the scalp etc. and an analysis was carried out making use of the X2 and Fisher’s exact tests. (Fiona Brown et al., 2000) When the study compared the vomiters to the non-vomiters, it found that about 15.8% of the 463 took to vomiting after the injury. The associated factors that were identified in connection with vomiting were a past history of motion sickness and vomiting. The study concluded that “vomiting alone does not have a role in decision making regarding further investigation of skull or brain”. (Fiona Brown et al., 2000) However, in another study conducted by (Nee PA., et al., 1999) involving 2581 children, the incidence of PTV was quite similar to the Brown and colleagues study, but the incidence of skull fracture in children showed 33%. From all the data collected, the study results showed that there was an association between a vomiting episode in children after an injury to the head and the risk of fracture. (Nee PA., et al., 1999) In another study conducted by (Dunning et al., 2004) in the Children’s Head Injury for Algorithms for the identification of Clinical Events Study (CHALICE) in reference to the current NICE (National Institute of Clinical Excellence) Guidelines and the guidelines of the Royal College of Surgeons (RCS) which was already in use, results showed that the NICE guidelines had much better outcomes than the RCS guidelines that involved CT scans for children with head injuries. In order to make an investigation of the impact each of the guidelines had on patient care, about 11,000 children with head injuries were included in a comprehensive study. (Dunning et al., 2004) According to the RCS Guidelines, approximately 171 CT scans (1.6%) were required, but according to the NICE Guidelines about 987 CT scans (8.7%) were required. One of the criteria for marking high risk patients under 12 years was vomiting and according to NICE Guidelines only 714 patients (6.5%) were at high risk. However, the CT scan rate would vary between 6% to 8% depending upon how the vomiting recommendation is applied by the clinicians. (Dunning et al., 2004) According to the NICE guidelines the same is applied for children and adults as well, though excessive vomiting is found in children. The study found that making use of the vomiting criteria for interpretation, while 6.3 % was the mean CT rate, the upper limit of requests for CT scans would rise to about 11% in all emergency departments. The study concluded that requested CT scans would be performed on children with head injury based on the presence of vomiting. (Dunning et al., 2004) However, (Brenner D. et al., 2001) is of the opinion that unless there is great concern about a severe brain injury, where a CT scan should be avoided since it is not good to expose the child to radiation. Therefore, a thorough evaluation of the injured child is of utmost importance besides good monitoring of the symptoms. When vomiting is recurrent, the head injury is taken to be a serious. According to (Schutzman SA, et al., 2001) a CT scan could be recommended when there are signs and symptoms of great concern during the examination such as loss of consciousness, fracture of the skull, persistent vomiting and many other behavioral changes. Warning of a second impact syndrome, (Kirkwood MW, et al., 2006) states that, children should be kept away from play for a certain period of time, to minimize the risk of further fatal complications. Children suffering from brain injury should be closely monitored before being allowed to return to sports. (Carroll LJ. et al., (2005) The National Institute of Neurological Disorders and Stroke (NINDS) carry on extensive and intensive research in the area of TBI in the laboratories of the National Institute of Health (NIH). www.ninds.nih.gov In addition it supports the research in TBI by offering grants to various distinguished medical institutions in the country. Research scientists work in these laboratories to find better interventions and strategies to help patients suffering from TBI by devising better methods to improve recovery. www.ninds.nih.gov Identifying the degree of damage A head injury should not be taken for granted and treated lightly because further damage to the brain could occur. Therefore, immediate assistance is vital to prevent further catastrophe and result in broad range of disparate outcomes. In the early stages of the recovery process, children identified with traumatic brain injury (TBI) are classified according to the degree of impaired consciousness after testing them on the Glasgow Coma Scale (GCS) (Anne Frances Cronin, (2000) Conclusion Head injury should be treated immediately in order to curb fatal complications. Research shows that vomiting recurrently is a good indicator of moderate to severe brain damage. Research has also shed light on the fact that little or no vomiting indicates that the child has suffered only a minor injury. According to the impact of the damage, necessary action should be taken to avoid further problems. Research has also shown that since the brain of the child is still developing, any injury experienced by the brain could alter the course of development related to different functions. Though after a brain injury, the building blocks of learning are retained and made use of , in very young children there are very few learning building blocks and therefore they are prone to become handicapped learners and may need special attention from the teachers as well as care givers. Studies have also shown that the TBI effects may not surface directly after the injury, but could be apparently seen in the course of the child’s development. References Anne Frances Cronin, (2000) The American Journal of Occupational Therapy. West Virginia University, Morgantown, West Virginia 26505; Atabaki SM. Pediatric head injury. Pediatr Rev. 2007;28(6):215-224. www.nlm.nih.gov/medlineplus/ency/article/000028.htm Brown FD, Brown J, Beattie TF. Why do children vomit after minor head injury? J Accid Emerg Med 2000;17:268–71. Carroll LJ. et al., (2004) Prognosis for mild traumatic brain injury: results of the WHO collaborative Centre Task Force on mild traumatic Brain injury. J Rehabil Med. 2004:84. Dunning et al., (2004) The Implications of NICE Guidelines on the Management of Children Presenting with Head Injury. Gedeit Rainer. Head Injury. Pediatrics in Review. 2001; 22: 118 - 124 Heegaard WG, Biros MH. Head. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. St. Louis, Mo: Mosby; 2009:chap. 38. www.nlm.nih.gov/medlineplus/ency/article/000028.html Kirkwood MW. et al., (2006) Pediatric Sport – related concussion: a review of the clinical management of an oft- neglected population. Pediatrics. 117: 1359. Nee PA, Hadfield JM, Yates DW, et al. Significance of vomiting after head injury. J Neurol Neurosurg Psychiatry1999; 66:470–3. Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 830. Traumatic Brain Injury. The National Institute of Neurological Disorders and Stroke. (NINDS) www.ninds.nih.gov Read More