Head Injury and.......

91W · Post by **91W** » August 21st, 2006, 9:17 pm

Here is a good one. Dirt Bike vs. tree and then house. Small bike 250cc male subject rode into a tree at unknown speed hitting hard enough to strip a good size chunk of bark off and then continued into a house. Bike had moderate damage to front end. Pt. was not wearing a helmet or any protective clothing. GCS of 13 on arrival reported to be unresponsive by first responders on scene. He was awake and confused after about five min. Elevated BP, tachy at 120 initially. All the S/S of a good concusion going on.

Here is where it got tricky, A three lead shows PRI of .04 blunted QRS and ST depression in II and III. The heart rate then fluctuated from 40-90. No 12 lead due to 2 min from scene to ER. 17 years old with no significant Med History.

Has any Medics or Docs seen a BBB from blunt force trauma. This was not my run but we had a good discussion about it. I am just trying to learn since the hospital won't let us follow up due to HIPPA. The EKG also looked like A-Fib in lead I but there were P waves present in II and III. I was told there were no muscle tremors and the medic that placed the leads is very particular so the placement was right. Did not look like artifact either. No physical findings of any chest trauma present. Pt was not alert enough to vocalize anything other than "what happened". I am stumped as to the Cardiac issue, hoping that someones experiance might educate me. I may be way off on the BBB since no 12 lead was done.

91W · Post by **91W** » August 22nd, 2006, 1:53 pm

Doc wrote:BBB, as a dysrhythmia, is a well-accepted manifestation of blunt chest/myocardial trauma. However, you can't diagnose one without V1 in a 12 lead.

Check Six,
Doc

Thanks Doc, I am aware of the V1 issue and I would not have done one either being so close to the hospital, not worth the time spent when there is obviously something that could take the pt south quickly and the er is that close. HIPPA around here sucks once the pt is transfered to er staff our involvment stops and the hospital says that they have to get pt or family approval to release info.