Shot in the head. Possible to stay alive?
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dun think so... any1 watching heroes season 2 wud know
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Originally posted by fymk:errr.... I don't think pressure bandages will help with internal haemorrhaging within the skull. They might worsen the intracranial pressure.
True.
I believe no matter what case of Head Injury, the ED will order a stat CT head at least to confirm that there are no ICH (intralcranial haemorrhage), SDH (subdural haemorrhage) or SAH (subarachnoid haemorrhage) first, before doing anything. - this is provided the patient's vitals are STABLE enough to withstand the to and fro trip to the CT room.
Kindly noted that head pressure dressing = crepe bandage, not estoplaste.
Usually the neurosurgeons will remove the affected part of the skull to facilitate surgery to evacuate the bleeding (craniotomy) as well as the bone fragments.
During surgery, they usually insert a device (but that depends on how bad the wound is and the main qualifiers are very low levels of consciousness aka score 8 or less a/c to the Glasgow Coma Scale) to monitor the intracranial pressure of the patient after surgery . It is a little thing that sticks out of the patient's head which is attached to a monitor to check for raised intracranial pressure.
That device is called a EVD - External Ventricular Device. It has 2 main uses.
1. to measure ICP- Intracrainal Pressure (only in NICU (neuro ICU))
2. to drain cerebral spinal fluid direct from the ventriculars of the brain.
However this device might not be required for patients with gunshot wounds.
It is commonly used for patients with Meningitis, hydrocephalus, or even for pts post tumor removal.
As for a post foreign body (in the case of a bullet) removal, an EVD is not always required, depending on the location the foreign body.
Drop in GCS does not always mean that pt has a increase ICP. Drop in GCS could happen to a pt with a ischemic or hamorrhage stroke too.
GCS is like a tool for us to detect changes in the neurological state.
Anyway, ED generally WILL NOT send patients with GCS less then 8 to general ward. Normally these patients will be admited direct to HD or ICU.
If it is a direct hit to the brain stem, instantaneous death. If it is a hit which affects the side of the brain but missed the thalamus, brainstem - patient may survive. People can still survive with half a brain. Depending on the force of the entry and exit of the bullet. -
Sorry to disappoint you.Originally posted by tankee1981:Arh...doctor is in the house! A neurosurgeon i presume?
I'm NOT a doctor, and I don't think a neurosurgeon has the luxary of time to log on to discussion forums.
I'm just a humble health care worker working in neuro setting.
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EVD is also used for non penetrating blunt force trauma to the head. Yes it may be not as commonly required for gunshot wounds to the head. The reason why they insert an EVD is to monitor for intracranial hypertension in a penetrating trauma. If it is half the brain blown out , I doubt that they can insert an EVD in any way- they won't because first of all - an enclosed skull adds the pressure - if one part of the skull bone gets blown out ....well no pressure- just a risk of something more interesting . 2nd of all, survival rate is as good as miraculous.Originally posted by C-100:
I believe no matter what case of Head Injury, the ED will order a stat CT head at least to confirm that there are no ICH (intralcranial haemorrhage), SDH (subdural haemorrhage) or SAH (subarachnoid haemorrhage) first, before doing anything. - this is provided the patient's vitals are STABLE enough to withstand the to and fro trip to the CT room.
Kindly noted that head pressure dressing = crepe bandage, not estoplaste.
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Yes . emergency CTs are frequently used. But first in gun shot wounds they assess the viability of CT scans after they stabilised the patients.
X rays may be sufficient in severe shots to the head in cases whereby the case won't make it to the CT scan and surgery in time.
First thing is stablise the patient . Hence you have portable X ray machines to take pictures of the skull and cervical spine. Second thing after they stabilized - the patient goes for CT scan.
Textbook classics say CT scan necessary but in real life , theory differs. Like they all say - it is damn rare to get the textbook case in real life.
The common key rule : stabilize, blood results (especially clotting factors) and scan , then surgery. I remember sometimes neurosurgeons can get more creative with interesting cases. I know there was one case they did an exploration quickly , evacuate the bleeding (there are techniques that do not require GA - general anaesthesia now) , stabilise , did CT scan, second round of more aggressive decompression under GA aka they really open up everything and target the areas.
If the CT scan shows more bleeds, surgical decompression is done depending on the viability of the patient survival potential.
Sometimes if survival is deem so poor after assessment - they won't do anything but conservative management. Usually those cases have almost no responses , no hope of survival (meaning that a surgery won't save them but kill them instead) and waiting to die.
And sometimes if the bullet isn't doing anything to the victim - they don't remove it unless the surgical benefits outweigh that of leaving the bullet inside. This is because surgery always bring on the possibility of dying on the operating theatre.
[quote]
That device is called a EVD - External Ventricular Device. It has 2 main uses.
1. to measure ICP- Intracrainal Pressure (only in NICU (neuro ICU))
2. to drain cerebral spinal fluid direct from the ventriculars of the brain.
However this device might not be required for patients with gunshot wounds.
It is commonly used for patients with Meningitis, hydrocephalus, or even for pts post tumor removal.
As for a post foreign body (in the case of a bullet) removal, an EVD is not always required, depending on the location the foreign body.
Drop in GCS does not always mean that pt has a increase ICP. Drop in GCS could happen to a pt with a ischemic or hamorrhage stroke too.
GCS is like a tool for us to detect changes in the neurological state.
Anyway, ED generally WILL NOT send patients with GCS less then 8 to general ward. Normally these patients will be admited direct to HD or ICU.
EVD may be used more frequently if they cannot remove the bullet fragments due to its lodging on the vital sites.
To be clear on what I said , for the GCS scores - hence they are in brackets as "main qualifiers" together with the severity and type of the wound for EVD insertions, not ICP measurement.
Sometimes they just don't remove the bullet or its fragments if removing it will have a higher risk of death. So not every victim who survives a gunshot wound to the head will end up with the removal of the bullet from their brain.
The ED will always send people still alive with penetrating (note: penetrating as in bullet entry) gunshot wounds to the head straight to HDU or ICU regardless of their GCS state. More so ICU than HDU. Never the general ward unless you are talking about a very very superficial non penetrating bullet graze to the head (just epidermal involvement) and nothing else. -
Definitely. Their inhibition is gone ....so whatever you do - DO NOT PISS THEM OFF!Originally posted by Gedanken:Hey, whack the frontal lobe and they'll be the life of the party.
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warning: GORE!
if mod think this is not good ill remove it. -
just thinking, assuming there are trace magnetic substances in the bullet, would an MRI not screw the guy up even worse since a giant magnet is used? Also possible are induced currents (leading to joule heating) and induction heating that may fry the guy's brains...
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OMFG!!! ZOMBIE!!!Originally posted by alleggerita:I remember I watched one episode on Discovery Channel about a poor girl whose right brain was totally removed..She was skiing when she had a fall and ruptured one of the blood vessels in her neck..she didn't know it..all she had was very serious headaches every now and then..and it can be so serious until she becomes half paralysed..
The doctors couldn't tell what's wrong..but finally a doctor suspected stroke and did a MRI for her and finally discovered the truth..the quickly operated on her but her brain just kept swelling..removing part of the skull temporarily soon didn't work anymore, so they cut off dead parts of the brain to give it more space to swell..but it still wouldn't stop swelling and she risked squeezing her own brain to death..so in the end they decided to remove the whole right brain because it's nearly dead already..
So after removing her right brain, she finally start to show improvements and started to heal..and by right, by removing the right brain it means the left half of her body should be paralysed..But, deep breath, nearly her whole body is still functional!!!
And this was because her left brain decided to take up the duties of the right brain..she not only can work now, but she can walk by herself (she's not even wheelchair-bound!) and talk quite properly..AMAZING! This is pure miracle..
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Very gruesome. Stay away if you have a weak stomach.
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Gawd damn! How bloody many executions were they performing at the same time in that first photo?!
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There are always conducted en masse (speling?).
But it seems bullet in the head will be replaced by chemical execution in the form of "Execution Bus". Google "China Execution Bus" and you'll find a lot of info.
While it is true that China crime rate is sky high, they are overdoing the executions. -
those that kena shot don't look real leh...
