Odd head injury -- or no head injury at all

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I vote for possible GHB... we see a fair amount of it here.  Decreased resp.
drive, decreased LOC, pronounced psychomotor agitation in some cases.
Doesn't show on most tox screens, has a synergistic effect w/ ETOH... 

Cheers,
Shane

-----Original Message-----
From: Jim Ouellet [mailto:hlmtxprt at yahoo.com] 
Sent: Friday, September 01, 2006 6:44 PM
To: trauma-list at trauma.org
Subject: Odd head injury -- or no head injury at all


I suspect your patient may have been comatose for
reasons other than blunt head trauma.  In fact, I
suspect he has no blunt head trauma at all because his
memory of events around the time of his fall/fractures
is quite clear.  Memory / amnesia for events
immediately around the trauma are considered the most
sensitive indicator of concussion and blunt head
injury -- at least the last time I looked at the
literature on it -- and his memory of those events
seems to be fine.   Negative cranial CT.  And I've
never seen DAI that was so quickly and completely
overcome (as opposed to the usual long rehab and
permanent disabilities.)    

Beyond being extremely skeptical of blunt force head
trauma as a cause, I'm hard pressed to offer any other
explanation for his overnight coma.   

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