Journal Club #2 with Andrew Brackins MSIV
Topic today – Traumatic brain injury or concussion is a significant problem in young adults and children. What do we know about the reasons why some people suffer longer term symptoms? What can we do to mitigate risk going forward? Fish oil is an omega 3 fatty acid that has recently gained attention as a possible therapeutic pre and post head trauma. Let us explore the head injury landscape together in this Journal Club episode.
Sports are great, but your child can have too much of a good thing. Your child can learn a lot of valuable skills and life lessons on the court or field, but at some point, the physical and mental rigor of sports can be too much, leading to mental and physical fatigue and injury. In this episode of DocSmo.com, Dr Smolen reviews the AAP guidelines for limiting competitive sports and gives you some common sense guidelines of his own. Continue reading
Doc Smo here, your pedcast host. Thank you for joining me today for what I hope will be an interesting edition of docsmo.com, the place where we discuss all things pediatric, all the way from the “onesie” to the “three-piecie”…and everything in between. Today I’m going to tell you about an interesting experience I had a few weeks ago when I was doing a check up in the office. The patient and his mother was there, the child being about 10 years old. The subject of trampolines came up (as it always does in my checkups with older children), and I was giving this young man my usual warning about not doing flips on trampoline. I never want to see a child have a serious head or neck injury from a trampoline accident, or any other activity for that matter. While I was warning this child not to do flips on a trampoline because the risk of a serious neck injury, this child’s mom got a really pained look on her face. I stopped the conversation and asked her if anything was wrong, and she proceeded to tell me what happened to her when she was 12 years old… in her backyard, jumping on a trampoline.
Here is what she told us: her family had a trampoline in their backyard for the kids to play on. She wasn’t supposed to be on the trampoline, and she certainly wasn’t supposed to do stunts like flips on it, especially when she was home by herself. But she played on it anyway. Then she told us she was doing a somersault and she flipped off the trampoline and came down on the back of her neck and head. She told us that as soon as she hit the ground she knew something terrible had happened. She was not able to move her arms or legs, and she thought she had broken her neck. Remember, she was by herself, laying on the ground, scared to death to move her head, thinking her neck was broken. Her arms and legs were limp and heavy, not under her control. What a horrible experience, no help in sight, scared to move her neck thinking it was broken, and convinced that she would never move again. What could she do? So she just laid there for what must’ve seemed like an eternity. After about a half an hour of agony, she began to get feeling and movement in her arms and legs. A miracle…perhaps, but more likely the “concussion” to her spine began to clear. After her arms and legs began to move, she finally got up enough nerve to move her neck and she realized that she hadn’t broken neck, but rather she just had a horrible blow to her spine and was temporarily paralyzed.
She had come within millimeters of actually fracturing her spine and being a quadriplegic for the rest of her life, and she knew it. What good fortune she had not to actually break her neck. Finally she got up and kept that fall a secret from everyone, including her parents, until that day in my office! She had never told a soul about her fall until that day in that examining room when she relived every moment of that terrifying event. She knew all too well what I was discussing with her children, and she was glad that we were talking about this subject so that hopefully no other child, especially a child of hers, would ever have to endure such a horrible event… or worse.
So here is the takeaway message from this story for your family: make sure you take the time to share stories of your childhood that might benefit your children, just like this mother did. When your children are old enough, tell them about the people you knew who got into cars after drinking when you were in high school and what terrible things happened to them. Tell them about the kids who got hurt playing with things that they knew they shouldn’t have been playing with like explosives, knives, firearms, or even drugs and alcohol. Tell them what happened to your friends who didn’t take school seriously and do their work, choosing instead to just get by. Make sure you share your treasure trove of life experience with your kids so they can benefit from your experiences. I think you will find that they’re very interested in what you have learned and experienced. Even if they don’t act like they are listening to you, they are probably taking in every word you say. I can guarantee you the kids in that exam room heard every word their mother said that day, and that they will never do flips on trampoline… and that’s a really good thing!
Thanks for sharing some of your precious time with me today. My audience is really growing and for that, I want to thank you. If you are new to the DocSmo blog, take a few minutes to explore literally hundreds of articles and pedcasts. I think you will be glad you did. While you are there or on the DocSmo iTunes site, take a moment to leave a comment or a review. This is your pedcast host, Dr. Paul Smolen, reminding you to move your lips, and tell your kids not to do flips. Until next time.
Spinal cord injuries often involve young people but few teens and college students understand the potentially life threatening risks that come with playing many popular sports. Unfortunately, with their youth often comes a feeling of invulnerability, and the belief that they are impervious to injury. It’s all part of being young, but all it only takes is one fall, or one bad tackle to turn a cheerleading stunt or football game into a literal nightmare. Spinal cord injury awareness is often overlooked during training, possibly because concussions and other more common injuries take the forefront. Recently, the Center for Disease Control has provided some specifics with regards to spinal injuries. According to their statistics, as many as 20,000 spinal cord injuries occur every year, with 12% resulting from sports, and most new cases involve 15-35 year olds. In 2008, 14 injuries resulting in some degree of paralysis were reported, and over the past ten years, the double-digit trend has continued to escalate. Though the numbers may seem small in comparison to other sports injuries, these life-changing and life-threatening injuries could happen at any time to anyone.
The cervical spine is a crucial, highly vulnerable area that safeguards the spinal cord connecting the body to the brain. Spinal cord injuries often occur when athletes tuck or bend their heads towards their chests during a fall. When the head makes contact with the ground or other obstacle, the sensitive cervical vertebrae are jarred, resulting in most commonly in sprains, or stingers (a temporary injury where the head or neck is jerked to one side with the shoulder going in the opposite direction), from which most young people recover. Other spinal cord injuries are much more serious and permanent. A ruptured disk is a long-term and very painful injury, while a fractured vertebra, more commonly known as a broken neck, is life threatening. If the spinal cord is severed, paralysis or even death may result.
In light of the increased numbers of spinal cord injuries, many schools are trying to institute more safety regulations and are training more highly certified athletic trainers in proper safety techniques to prevent cervical spinal injuries. Coaches are teaching their football players to tackle with the head up, instead of tucked,. A program to prevent “spearing”-headfirst contact in football- has been around since 1976, but it hasn’t been enforced consistently. Most colleges and two-thirds of secondary schools have hired highly trained, qualified athletic trainers who are specially trained to quickly recognize and detect spinal cord injuries. Some schools even run emergency-response drills on the field with players, first-responders, and athletic trainers in case of a spinal cord injury to learn proper techniques in removing helmets, face gear, and shoulder pads, and immobilizing techniques to prevent further injuries. A few high schools are also allowing parents to sit in on coach and athletic trainer training sessions to increase awareness on spinal cord injuries. If your teen’s school offers these programs, try to attend a session so you can have a one-on-one talk with your teen about the dangers and all of the available safety techniques. If your teen’s school has yet to implement these programs, let administrators know that spinal cord injuries are real and that prevention programs are important. Increasing awareness is the key to beginning the important task of prevention of spinal injuries
Your comments are welcome at my blog, www.docsmo.com. Feel free to share your thoughts and stories there. Until next time.
1. Wall Street Journal, written by Laura Landro, September 16, 2013 edition.
Written collaboratively by Keri Register and Paul Smolen M.D.
Now that summer has rolled around, the risk of heat stroke for children increases dramatically. Every year, children are tragically injured or lost when well-meaning, loving parents or caregivers leave a child in their car. Whether the child is left in the car when parents run in to the grocery store, go in to school to pick up a sibling, or the child gets into the car to play without the caregivers’ knowledge, the results can be equally heartbreaking. Last year in the US, 32 children died from heat stroke, with 75% of deaths occurring in the summer months. This is a loss of life that can be prevented, and we should make every effort to ensure that fewer children suffer the effects of heat stroke each and every year.
Recently, the Department of Transportation’s National Highway Traffic Administration partnered with children’s hospitals and Safe Kids Worldwide to increase awareness on heat stroke and to dismantle many misconceptions. We often don’t realize just how quickly heat stroke can occur, especially in young children under the age of fouryears. With temperatures in the low 80s, heat stroke may develop in as little as ten minutes, even if the windows are rolled down a couple of inches. Children’s bodies overheat much more quickly than an adults’. Even if a child doesn’t die from heat stroke, a rapid rise in body temperature can result in permanent brain injury, hearing loss, blindness, and much more. The effects of heat stroke are devastating and can affect anyone.
Thankfully, there are many steps conscientious caregivers and parents can take to prevent heat stroke. If we all simply take a moment to think before stepping out of the car, we can save lives. Always look in the front and back seats to ensure that no child is left behind, and leave something you use often like a purse or briefcase next to the child seat to remind you to check. You can also easily leave a sticky note on the dashboard to remind yourself. Never leave a child unattended in the car, even if it doesn’t seem that hot, the windows are rolled down, or the engine is running. Finally, teach your children that the car is not a play place and keep the keys out of reach. These simple steps can prevent tragedy. As the Department of Transportation’s slogan goes, “Where’s baby? Look before you lock.”
Your comments are welcome at www.docsmo.com. Until next time.
Written collaboratively by Keri Register and Paul Smolen MD
The sports season and the injuries that inevitably accompany it are upon us. Parents and coaches should have all the tools possible to respond when injuries occur, especially serious injuries such as concussions. Concussions are especially common in rough sports such as football and wrestling; they occur when the brain is thrust against the inside of the skull, damaging vital tissues in the process. We’ve all heard about the dangers of concussions, but we may not be able to recognize all the symptoms and their severity in time to take appropriate action. With the powers of technology, however, now there’s an app for that!
The Concussion Recognition and Response app, or CRR, helps parents and coaches identify the first signs of a concussion and advises them on the medical measures that need to be taken in case of injury. In less than five minutes, parents can review a checklist of concussive symptoms including dizziness, headaches, and confusion to decide what action to take. What’s more, if the child exhibits symptoms of concussion, the app allows parents to record the symptoms and email them to local health care providers for a professional opinion.
When time is of the essence, this app offers good help during scary situations. Remember, however, that as great as technology is, it’s not as reliable as a real-life doctor; if there’s the smallest chance that your child has a concussion, please consult your doctor. As the old saying goes, “A stitch in time saves nine.” In other words, early recognition of a serious brain injury may avert further damage later.
Your comments are welcome at my blog, www.docsmo.com. While you are there, feel free to explore the literally hundreds of podcasts and articles, all created for you on my blog. Until next time!
Written by Keri Register and Paul Smolen M.D.
Supplementary Sources: http://www.mayoclinic.com/health/concussion/DS00320/DSECTION=causes