Management of Penetrating Head Injuries: Lessons Learned

2014 ◽  
Vol 82 (1-2) ◽  
pp. 25-26 ◽  
Author(s):  
Gerald A. Grant
Keyword(s):  
Head Injuries ◽  
Lessons Learned

scholarly journals Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients

2015 ◽  
Vol 16 (3) ◽  
pp. 340-345 ◽  
Author(s):  
Brian K. Owler ◽  
Kathryn A. Browning Carmo ◽  
Wendy Bladwell ◽  
T. Arieta Fa’asalele ◽  
Jane Roxburgh ◽  
...  
Keyword(s):  
Head Injuries ◽  
Pediatric Neurosurgery ◽  
Lessons Learned ◽  
Neurological Deficits ◽  
Pediatric Care ◽  
Start Time ◽  
Tertiary Center ◽  
Metropolitan Hospital ◽  
Time Critical ◽  
Median Interval

OBJECT Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients’ distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. METHODS A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. RESULTS Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29–05:20 hours). The median distance traveled to reach a patient was 232 km (range 23–637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47–03:37 hours). The estimated median “time saved” was approximately 3:00 hours (IQR 1:44–3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56–10:08 hours). CONCLUSIONS Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

Wartime decompressive craniectomy: technique and lessons learned

2010 ◽  
Vol 28 (5) ◽  
pp. E2 ◽  
Author(s):  
Brian T. Ragel ◽  
Paul Klimo ◽  
Jonathan E. Martin ◽  
Richard J. Teff ◽  
Hans E. Bakken ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Head Injuries ◽  
Gunshot Wounds ◽  
Lessons Learned ◽  
Military Hospitals ◽  
Closed Head Injuries ◽  
Dural Closure ◽  
War Zone ◽  
Time Period ◽  
Life Saving

Object Decompressive craniectomy (DC) with dural expansion is a life-saving neurosurgical procedure performed for recalcitrant intracranial hypertension due to trauma, stroke, and a multitude of other etiologies. Illustratively, we describe technique and lessons learned using DC for battlefield trauma. Methods Neurosurgical operative logs from service (October 2007 to September 2009) in Afghanistan that detail DC cases for trauma were analyzed. Illustrative examples of frontotemporoparietal and bifrontal DC that depict battlefield experience performing these procedures are presented with attention drawn to the L.G. Kempe hemispherectomy incision, brainstem decompression techniques, and dural onlay substitutes. Results Ninety craniotomies were performed for trauma over the time period analyzed. Of these, 28 (31%) were DCs. Of the 28 DCs, 24 (86%) were frontotemporoparietal DCs, 7 (25%) were bifrontal DCs, and 2 (7%) were suboccipital DCs. Decompressive craniectomies were performed for 19 penetrating head injuries (13 gunshot wounds and 6 explosions) and 9 severe closed head injuries (6 war-related explosions and 3 others). Conclusions Thirty-one percent of craniotomies performed for trauma were DCs. Battlefield neurosurgeons use DC to allow for safe transfer of neurologically ill patients to tertiary military hospitals, which can be located 8–18 hours from a war zone. The authors recommend the L.G. Kempe incision for blood supply preservation, large craniectomies to prevent brain strangulation over bone edges, minimal brain debridement, adequate brainstem decompression, and dural onlay substitutes for dural closure.

scholarly journals Managing military penetrating brain injuries in the war zone: lessons learned

2018 ◽  
Vol 45 (6) ◽  
pp. E6 ◽  
Author(s):  
Hussein Fathalla ◽  
Ahmed Ashry ◽  
Ahmed El-Fiki
Keyword(s):  
Brain Injuries ◽  
Vegetative State ◽  
Head Injuries ◽  
Persistent Vegetative State ◽  
Lessons Learned ◽  
Predictors Of Mortality ◽  
Poor Outcome ◽  
War Zone ◽  
Imaging Characteristics ◽  
Collective Experience

OBJECTIVEManaging penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues.METHODSThis study was a retrospective review of 102 patients with penetrating military missile head injuries treated by the authors in various facilities in northern Sinai between 2011 and 2018. Patient demographics, clinical characteristics, imaging characteristics, postoperative complications, and Glasgow Outcome Scale (GOS) scores were recorded for each patient. Several variables associated with mortality and poor outcome that were derived from the literature were analyzed, in addition to variables obtained by direct observation by the authors over time.RESULTSThere were 50 patients (49%) with GOS score of 1 (death), 12 patients (11.8%) with GOS score of 2 (survivors in persistent vegetative state), and 40 survivors (39.2%) with varying degrees of disability on the last follow-up evaluation. The authors identified an anatomical danger zone that was found to predict mortality when traversed. Bilateral dilated fixed pupils and low Glasgow Coma Scale score on admission were also found to be independent predictors of mortality and poor outcome. Based on these findings, a protocol was developed for managing these patients in the war zone.CONCLUSIONSManaging military penetrating head injuries in the war zone is different than civilian gunshot head injuries encountered by most neurosurgeons in urban cities. The authors developed a simple protocol for managing military penetrating injuries in the war zone. They also describe important lessons learned from this experience.

Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

2020 ◽  
Vol 5 (1) ◽  
pp. 88-96
Author(s):  
Mary R. T. Kennedy
Keyword(s):  
College Students ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sense Of Self ◽  
Scientific Evidence ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Speech Language Pathologists ◽  
The Brain ◽  
Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

Experiences With and Lessons Learned From Developing, Implementing, and Evaluating a Support Program for Older Hearing Aid Users and Their Communication Partners in the Hearing Aid Dispensing Setting

2020 ◽  
Vol 29 (3S) ◽  
pp. 638-647 ◽  
Author(s):  
Janine F. J. Meijerink ◽  
Marieke Pronk ◽  
Sophia E. Kramer
Keyword(s):  
Large Scale ◽  
Hearing Aid ◽  
Critical Discussion ◽  
Lessons Learned ◽  
Research Note ◽  
Support Program ◽  
Large Sample Size ◽  
Long Term Effects ◽  
Communication Program ◽  
Communication Partners

Purpose The SUpport PRogram (SUPR) study was carried out in the context of a private academic partnership and is the first study to evaluate the long-term effects of a communication program (SUPR) for older hearing aid users and their communication partners on a large scale in a hearing aid dispensing setting. The purpose of this research note is to reflect on the lessons that we learned during the different development, implementation, and evaluation phases of the SUPR project. Procedure This research note describes the procedures that were followed during the different phases of the SUPR project and provides a critical discussion to describe the strengths and weaknesses of the approach taken. Conclusion This research note might provide researchers and intervention developers with useful insights as to how aural rehabilitation interventions, such as the SUPR, can be developed by incorporating the needs of the different stakeholders, evaluated by using a robust research design (including a large sample size and a longer term follow-up assessment), and implemented widely by collaborating with a private partner (hearing aid dispensing practice chain).

Maximizing Outcomes in Group Treatment of Aphasia: Lessons Learned From a Community-Based Center

2014 ◽  
Vol 24 (3) ◽  
pp. 100-105 ◽  
Author(s):  
Darlene Williamson
Keyword(s):  
Group Treatment ◽  
Treatment Protocol ◽  
Lessons Learned ◽  
Group Program ◽  
Community Based ◽  
Multiple Treatment ◽  
Use Of Technology ◽  
Communication Impairments ◽  
Treatment Settings

Given the potential of long term intervention to positively influence speech/language and psychosocial domains, a treatment protocol was developed at the Stroke Comeback Center which addresses communication impairments arising from chronic aphasia. This article presents the details of this program including the group purposes and principles, the use of technology in groups, and the applicability of a group program across multiple treatment settings.

Experience With Grant Writing: Where Do I Even Begin?

2010 ◽  
Vol 11 (1) ◽  
pp. 21-24
Author(s):  
Nicole M. Mancini
Keyword(s):  
Lessons Learned ◽  
Economic Situation ◽  
Grant Writing ◽  
Personal Journey ◽  
Know How ◽  
Daunting Task

Abstract At first, grant writing may look like a daunting task. You may ask yourself, “Is it really worth the time and effort?” With today's economic situation, teachers and therapists need ways to supplement their programs and grants provide such an opportunity. However, many of us do not know how to get started. After a few experiences and many lessons learned, I have come to enjoy researching and writing grants to supplement my students' learning. It is well worth the time and effort. This article provides information about a personal journey, lessons learned, and resources to get you started.

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