Category Archives: Medical

Glasgow Coma Scale

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The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person’s level of consciousness after a brain injury.  The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. 

These three behaviours make up the three elements of the scale: eye, verbal, and motor. A person’s GCS score can range from 3 (completely unresponsive) to 15 (responsive).

This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalized patients and track their level of consciousness.

Unlike pretty much every other score, the lower GCS scores means a higher risk of death. However, the GCS score alone should not be used on its own to predict the outcome for an individual person with brain injury.  It’s simply a guide, that’s pretty much all.

Concussion learning by experts

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Amid growing evidence that repeated concussions and blows to the head can have long-term, possibly fatal outcomes, local concussion experts are working to better inform people about head injuries.

Specialists at Cape Regional Medical Center’s Concussion Center are gearing up for fall sports season injuries, typically to student athletes — although adults and seniors can have such injuries all year.

More awareness about head injuries is needed.

“There’s a misconception that concussions are strictly due to sports injuries, but we have a program and treatments that serve kids and adults who get concussions just as much from falls and car accidents, too,” said A.J. Weiss, concussion center rehabilitation and treatment manager.

Gov. Chris Christie earlier this year signed a law designating the third Thursday of September as Concussion Awareness Day in New Jersey. Legislators said they hoped awareness would lead to education about the serious consequences of concussions, treatment and resources.

Of the 2.8 million traumatic brain injury-related emergency department visits and hospitalizations in 2013, most were concussions, according to the federal Centers for Disease Control and Prevention, and about 300,000 children who were treated in a single year for a concussion or brain injury got hurt while playing sports or in recreation.

Scientists have explored more about concussions in recent years, especially as high rates of head injuries are found in sports such as football. Researchers have looked into how repeated head injuries and concussions could lead to chronic traumatic encephalopathy, a degenerative brain disease.

A report published in July in the Journal of the American Medical Association by Dr. Ann McKee, chief neurologist of VA Boston Healthcare System and director of the CTE Center at Boston University, said 110 of 111 brains of deceased National Football League players were found to have CTE.

“Part of what we do for education is informing people about second impact syndrome, which can be fatal,” Weiss said. “It happens when someone sustains a second concussion before the first one heals, and that could lead to weeks or months of therapy, permanent damage, or worst case, death.”

Concussion symptoms include dizziness, headache, vision trouble, sometimes brief unconsciousness, fatigue, poor balance, sensitivity to light, vomiting and disorientation, among others.

Cape Regional’s center, established in January 2016, encourages people to see a physician as soon as possible if they suspect a concussion. When a physician or other medical expert refers patients to the center, Weiss said, they will see that patient in less than 48 hours.

Some patients who come in with head injuries from sports, falls or car accidents come through the emergency department, he said, where they may be prescribed a CT scan, which can detect brain bleeds or skull fractures.

Though they are necessary in many cases, experts from the New Jersey Council of Children’s Hospitals and the New Jersey Hospital Association created the Safe CT Imaging Collaborate, which works to standardize protocols for head CT scans in children to decrease radiation exposure.

“Diagnostic radiation is very, very useful when used appropriately,” said Dr. Ernest Leva, associate professor and director of the Rutgers Robert Wood Johnson Medical Center’s Division of Pediatric Emergency Medicine. “But if it’s not used appropriately, it can be dangerous.”

Dori Davidson, 19, of Dennis Township, got a concussion not from sports, but from a slip and fall in August.

She visited a Cape Regional urgent care associated with the emergency department for a laceration on her head and was referred to the concussion center, where she got baseline testing, concussion care education and a treatment plan.

Davidson worked with experts in a combination of physical therapy and occupational therapy exercise Friday to strengthen her motor and cognitive capabilities. She worked with the Dynavision D2, a computerized board that tested her motor, physical and neurological skills.

The center, which has seven certified brain injury/concussion specialists trained in physical and occupational therapy, also works with a network of nearby pediatricians to reach children who may see their primary care doctors for head injuries.

Weiss said the center also works with neurologists who attend to patients with more complicated neurological issues stemming from a concussion.

No single test can diagnose someone with a concussion, but experts hope there will be one someday. In the meantime, they said, the best they can do is educate people on how serious concussion can be, the signs and symptoms and the available resources, such as Cape Regional’s specialized center.

“We emphasize everyone to get in early if they suspect a concussion injury,” Weiss said. “The last thing we want to see is people who don’t address their symptoms immediately, they get worse and we have a worse case on our hands.”

Take hits to the head seriously

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The president of the US knocked NFL on rules: ‘Concussions — ‘Uh oh, got a little ding on the head?' in 2016, and calling the rules “soft”.
While he's wrong, he's not alone in thinking that way. The reason for that is that if someone hasn't had an injury, or knows someone who has, they don't understand.
While concussions are sometimes invisible to the eye, the effects aren't.
I've got plenty of challenges, of that there's no doubt, but the fact that I'm visibly-disabled is a plus. Why? Because if I stop for a few seconds, and do something that isn't simply moving forward, someone usually stops, and asks me if I'd like some help.
What I don't understand is that some doctors consider traumatic brain injury and concussion as two separate diagnostic categories, when in truth, both reflect brain injury.
When people go to the hospital, after getting hit on the head, what's weird (wrong) is that concussion is sometimes termed, over "brain injury." The reason for that is strongly associated with earlier discharge from the hospital and earlier return to school activities, the researchers say.
But, with the reality that they're the same, and post-crash effects can appear later, researchers recommend that more specific descriptions of concussion and brain injury should be used. The reason for that is that a more detailed explanation can include elements that would warn of the potential occurrences of issues.
Using the term “mild traumatic brain injury” rather than “concussion” might help people better understand what they are dealing with and improve decisions about what the children should be allowed to do.

What is a concussion?

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As Will Smith made evident, concussions are more than a "bump on the head", way more.  What's also unusual is that a concussion can be received with impact to another part of the body, not even the head.  What's also unusual is that a concussion can be received with impact to another part of the body, not even the head.
If you're hit on your body somewhere, that makes your head move, sharply, to one side and then back, your brain hits your skull, and it's like hitting your head with a hammer.
If your kid is hit on the head by the ball in the game, and gets a big bump, it's more often than not simply a visible injury, and not a concussion. However, make sure that you pay attention to your kid, periodically ask them random questions that take a moment to think, and make sure they're alert.
Make sure that you take your kid to see a doctor if they show:
• Persistent or worsening headache• Imbalance
• Vomiting• Memory loss or confusion
• Mood changes, such as irritability
Signs and symptoms may not be noticeable right away,
but if your headaches, dizziness, confusion, and nausea persists,
you should see a doctor.

Check out the new medical facility!

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Richmond is served by an awesome group of medical folks, of that there's no question. However, where they operated from was a rental facility, owned and operated by a commercial venture, who decided on what's available strictly on cost. The facility was "accessible", but it met the minimum of access, but it wasn't.
This is where the doctors were before,
as tenants in a building owned by not-doctors
The entrance, up with two steps. Inside the front door was another rise, up four steps.
This is the view of the path, including the hill. In order to avoid the 4 stairs, I was required to go through the door, up the path, and ring a doorbell. I entered through the print-closet, with the printer and papers.
This is the pharmacy. Technically it's accessible, but while the door was powered, it opened and I was required to immediately turn 90 degrees to my right. Then, press a door-opener for the second door, that opened inwards.
Two years ago they began construction on a new facility, that would be both owned, and operated by, the medical facility. And, not only would it be fully-accessible, but the drug store would also move in! It opened 8 months ago, it's awesome, because they are!
Awesome new building
The building is where it is, and it's entirely theirs!

Not only is it accessible for me to walk in, but I can DRIVE in!

This is the doctor's offices.

OLYMPUS DIGITAL CAMERA

Not only can I get in to see my doctor, but also to the drug store!
Disabilities, in general, are being noticed more, and solutions are being put forward. This new building solves two significant challenges, in a magnificent way.