"talk and die" syndrome - potentially deadly head injury

[spenac]

How do you handle patients with apparent minor head trauma?

http://www.sciam.com/article.cfm?id=talk-and-die-richardson

"What is "talk and die" syndrome?

After a seemingly minor fall on the slopes, actress Natasha Richardson is reportedly suffering from a potentially deadly head injury"

"What is "talk and die" syndrome?

That refers to the fact that we always worry about people with head injuries that don't show up immediately, which is why we like to observe people after a head injury for 24 hours. Generally when we talk about "talk and die" it's usually a delayed bleed like an epidural hematoma."

"Did the fact that she delayed treatment for an hour put her at further risk?

Obviously, when it comes to treatment—the earlier, the better. If she had gotten a CT scan right away, doctors likely would have seen the bleed. From what I understand, however, she was examined by a medic, and she was doing fine. We don't typically scan patients unless there has been a more significant type of trauma. It sounds like everything was managed appropriately and this was one of these rare catastrophic events. Even for patients that do have delayed bleeds, most of them tend to do very well, particularly younger patients. They normally don't deteriorate that fast, and one has time to stabilize the situation, control the swelling and operate to relieve the blood clot if necessary."

Edited March 22, 2009 by spenac

[Jeepluv77]

As opinionated as some folks on this forum tend to be, I'm kind of surprised not to see any replies yet. Me personally, I guess I would have to be there. However, if she's a&oX3 you really can't force her to be looked at regardless of how nasty a head bump may look. I'm interested to see how this turns out, and I hope she's okay. The media tends to blow things way out of proportion so hopefully this is one of those cases. It is a very scary situation though. It's not like she's elderly and it doesn't mention if she has any disorders that could have made her more susceptible. Kind of bring it home that it could happen to anyone.

Edited March 23, 2009 by Jeepluv77

[chbare]

She died actually. Reports say it was from an epidural hematoma. This whole "talk and die" stuff is something new to me. Seems like another way of saying, "guess you were not well after all." This is not uncommon and regrettable ( thoughts go out to friends and family); however, we simply cannot rule out every problem. How many of us have taken a knock to the noggin, only to brush it off and develop no long term sequela?

Then, there are people who do develop problems. My wife's brother had a fall while doing house work recently. Bumped his head, but had no other complaints and went about his day without any problems. A few hours later he started vomiting and was taken to the ER. He had developed a SAH and was flown to a trauma center. He has since recovered with no known deficits; however, it just shows that you can never be really sure. However, are we going to rush to the ER and demand a CT every time we hit our head?

Take care,

chbare.

Edited March 23, 2009 by chbare

[Jeepluv77]

Wow. That's so sad. My father is an recovering alcoholic. Back in 2005, while he was still drinking heavily, he fell and hit his head. We took him to the er where a ct scan was performed and we were told he was fine. We took him home. Two days later we noticed he was not acting "right" (when they're an alcoholic it's hard to know exactly what right is) and was stumbling more than normal so we took him back. They did a repeat head ct, where they found bilateral subdural hemotomas. He ended up in the hospital for six weeks. He underwent two surgeries to remove blood and blood clots, has a permanent burr(sp?) hole still noticeable under his scalp, and has compression of of his brain. Somehow though, he has regained normal function, full memory back to childhood(minus the later drunken years), and has actually managed to regain his driving skills and license. Which also makes me wonder, how does a 30 year alcoholic that went in like that with a bac of 0.42 survive and go on to live a normal life while a seemingly healthy woman loses her life? Would it be just the fact that his bleed was apparently much slower?

[Doczilla]

Talk and Die Syndrome? For $%# sake. Lucid interval after epidural hematoma is well documented in the medical literature, but nobody calls it "talk and die syndrome".

Because of this, now every patient and parent of a child who has had a minor head trauma in the last week is coming to the ER demanding a head CT. This one incident is going to cause more cancer than asbestos.

Clinical decision rules (specifically, the Canadian Head CT rule, which is somewhat ironic given that she was injured in Canada) dictates that even with LOC up to 30min, if she has a normal neuro exam, normal mental status, no intoxication, etc., the chances of her having a clinically significant intracranial injury is extremely rare. We get a large number of minor head traumas that we don't scan because of clinical decision rules like this and the New Orleans Criteria, saving time, expense, and radiation. As long as they can be watched by a sober reasonable person, we send them home, with instructions to return if things worsen. Her case is a rare one, but unless there is something we're not being told, I wouldn't have insisted on scanning her immediately until she started complaining of the severe headache.

'zilla

[spenac]

From a medical journal.

http://www.medpagetoday.com/EmergencyMedic...yMedicine/13340

"Death of Actress Brings Attention to 'Talk and Die' Syndrome"

[Michael]

http://www.cnn.com/2009/HEALTH/03/26/head....ency/index.html

[wrmedic82]

Only thing I can say to this sad story is always advise patient's of the risks of not being evaluated. Im not saying they all have to be evaluated in the ER, but by a physician. Whether that be primary care, or a doc in a box. (not that I think highly of doc in a box places)

After you have given the patient enough information to make an informed decision, mindful that they are legally competent to make a rational decision. If they still want to take their chances and go on their own. Then its on them.

[HERBIE1]

From the report I read, she was NOT seen by a paramedic- the ALS crew was held up enroute and did not make patient contact because the patient did not want treatment. She signed a release and later developed symptoms. I wouldn't fault the original providers, assuming they gave the usual warnings.

[wrmedic82]

From the report I read, she was NOT seen by a paramedic- the ALS crew was held up enroute and did not make patient contact because the patient did not want treatment. She signed a release and later developed symptoms. I wouldn't fault the original providers, assuming they gave the usual warnings.

cant help stupid...that is a preexisting condition