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Fri Sep 1 08:44:00 BST 2006

Ooops

Meant decrease in ADH :)

m
----- Original Message ----- 
From: "Mike" <mmackinnon at cox.net>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Friday, September 01, 2006 12:41 AM
Subject: Re: Odd head injury


> How about diabetes insipidus? I know it typically takes days but is there 
> anychance it could be accelerated by dehydration from alcohol anyway? Not 
> sure if thats possible to get this bad this quick with DI.
>
> Common with head injury, ADH goes through the roof then confused?
>
> What was his urine specific gravity and osmo? How about BUN:Cr?
>
> Guy is dehydrated then has a head inj. ADH high losing fluids like crazy 
> with a shift intracellular and all the sudden you have cerebral edema.
>
> Dunno, this is a shot in the dark.
>
> m
> ----- Original Message ----- 
> From: <Walter.Mauritz at auva.at>
> To: <trauma-list at trauma.org>
> Sent: Thursday, August 31, 2006 11:40 PM
> Subject: RE: Odd head injury
>
>
> Dean,
>
> what was the alcohol level (or serum osmo)?
> If he had a couple of drinks just before the accident the full effect of
> alcohol intoxication may not have been apparent at admission.
>
> best wishes
>
> Walter Mauritz MD PhD
> Professor of Anesthesia and Critical Care Medicine
> Trauma Hospital "Lorenz Boehler"
> A - 1200 Vienna, AUSTRIA, EU
> phone: ++43 1 33110 789
> fax: ++43 1 33110 277
> e-mail: walter.mauritz at auva.at
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr
> <tch at sun.ac.za>
> Sent: Friday, September 01, 2006 6:59 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: Odd head injury
>
> Dean
>
> All I could suggest is rapidly reversing DAI, which is not usually
> visible on CT. Did he get a re-scan after the GCS drop or was that the
> first scan. Last q - did you check for "tik" drug?
>
> Tim
> Dr T C Hardcastle
> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
> ATLS  instructor and DSTC Cape Town Course Director
> Intern program Coordinator: Surgery
> Program Manager: Emergency Medicine (SU)
> Clinical Head (Director): Diana Princess of Wales Trauma Unit
> Department of Surgery Room 4064
> Tygerberg Hospital / University of Stellenbosch
> PO Box 19063
> Tygerberg 7505
> Western Cape
> South Africa
> e-mail: tch at sun.ac.za
> Cell: +27824681615
> Office: +27219389281 or 4911 pager 0302
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of Dean Lutrin
> Sent: Friday, September 01, 2006 1:44 AM
> To: 'Trauma &amp; Critical Care mailing list'
> Subject: Odd head injury
>
>
> Dear Listmembers
>
> I would like an opinion on a recent case I saw. Young male thrown off a
> bridge - didn't get any more details. Came in slightly confused (GCS
> 14/15)
> with a a fractured wrist and ankle. It was one of those nights in a
> Johannesburg trauma unit and I had to run off to sort out another
> patient
> and I left my patient with one of the interns. I wasn't too worried
> about
> him compared with the other patients I had to sort out. Came back to him
> an
> hour later and he was comatose. GCS 3/15. Intubated without drugs. CT
> brain
> normal. Nothing else on imaging aside from wrist and ankle. Ventilated
> overnight with good spontaneous respiratory effort and reactive pupils.
> GCS
> still 2/10. Next day started waking up quite nicely. Extubated 36 hours
> after initial injury with full recollection of everything up to arrival
> at
> hospital. Resources didn't allow me to CT again before extubation. Full
> toxic screen negative, but patient was drunk.
>
> Questions
>
> 1. was this just a concussion?
> 2. I have never seen a patient drop to 3/15 from 14/15 with a normal CT
> and
> then have a full recovery. Is it common?
> 3. Anything else could have caused it?
>
> Thanks
>
> Dean Lutrin
> JHB, SA
>
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Odd head injury