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While not evidence based I do believe the opinion of the stakeholder should be listened to. In that regard I must confess to having my first  ? significant head injury while snowboarding about 6 weeks ago.  I fell backwards with an incline of about 210 degrees ie: my fall from standing being 120 degrees banging my occiput on hard ice and not a very great velocity. I certainly felt stunned, loss of consciousness ?  hmm, probbaly not, stunned ?  Yes,  Dazed ?  yes, Stars ? yes. But I got up and continued. Okay no warfarin but a responsibility to look after my accompanying 9 year old. Post traumatic amnesia ?  No, Headaches ? No.
 
But later I wondered, how would I treat that history in my emergency department and how would my juniors have treated a patient with that history ?  Despite guidelines and percentages, at the end of the day I suspect a lot of us treat others as we would ourselves - with a degree of pragmatism . 
 
 
John Ryan
----- Original Message -----
From: [log in to unmask]>Duncan Peacock
To: [log in to unmask]>[log in to unmask]
Sent: Sunday, February 03, 2002 03:22
Subject: Re: Grey out

In motorsport medicine where you can get to motorcyclists within  60 to 90 seconds of the accident, there are a number who have a high delta v, or change in velocity that are unconscious when you get to them. With airway support and some oxygen, they come round and are neurologically "normal" in a minute or two.
Full assessment can fail to reveal any external evidence of head injury, nor any damage to their helmet. They are GCS 15 by the time they get into the ambulance with their fractured femur etc. There are others who are "out" for less than a minute who have got up by the time you reach them and are walking around neurologically normal, with no external injury, often they don't go to hospital, they often race again that day.............,(not if I have seen them though).
 
These people obviously have some transient brain malfunction and are "knocked out". I expect the majority don't have CT changes, or even get a CT. Other imaging such as MR may show axonal injury or other changes.
 
Its only with this sort of pre hospital care, when you get to the patient within a couple of minutes, that you get a chance to observe this. The pathophysiology I am sure happens off the race track as well.
 
Duncan Peacock
 
----- Original Message -----
From: Adrian Kerner
Sent: 02 February 2002 22:43
To: [log in to unmask]
Subject: Re: Grey out
 
Andy - I quote 'dazed', if they were out for seconds - I don't know if this is
really LOC - I like the tem 'grey out'!

Regards

Adrian

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