Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Let's start a new series. It is not a very interesting
subject, but oh so common. Head injuries are very common and
proper research has not been done in order to give us enough
guidance on the subject.
Bumps on the head can come for many reasons. Falls and faints
are the most common reasons and, of course, in the case of
fainting, we must rule out that the faint wasn't a result of
a medical problem, such as heart rhythm problem, seizure,
carotid sinus hypersensitivity, dehydration, anemia, low
blood sugar or orthostatic hypotension.
Heart rhythm problems are usually a problem of the elderly
and may indicate a need for a pacemaker, or that the heart
does not receive enough oxygen. These are usually sudden
faints, without any dizziness preceding them.
Seizures usually have some feeling before them that
"something is not right," and are characterized by shaking,
tongue biting, losing control of bladder function and
confusion afterwards. However, seizures can be without some
are even all of these components.
Carotid sinus and orthostatic hypotension are disorders of
the ability of the body to compensate for change in position,
and this can cause a faint.
Dehydration and anemia can also cause dizziness and weakness
before fainting.
The most common cause of fainting in children and young
adults remains the vasovagal syndrome -- medical lingo for
the common faint which may be due to emotional distress.
However, even in kids, an EKG must be done to rule out
another unusual cause of fainting called long QT syndrome
that may predispose to a dangerous condition. Blood tests are
rarely needed in most faints.
Falls are common and I must say a word about them.
Childproofing a house is difficult, but do your best. Do not
put toddlers in walkers. They prevent them from using their
protective instincts to brace in a fall. Gates are a good
idea if you have a second floor.
Supervise your child in the playground. While sand is a great
shock absorber, it harbors diseases from cats and pinworm. We
recommend rubber pads for playgrounds. Bike helmets are also
an important and not so expensive preventive measure.
Old people also must be careful. Falls in the home can come
from exposed cords, grandchildren's toys that have not been
put away, walking to the bathroom in the dark, falling
outside on wet patches after rains -- be careful.
Some first aid tips in falls. Do not force anything into the
mouth of a seizing patient. Do not move a broken limb. Do
call for help if the patient is unconscious and do apply
direct pressure to bleeding wounds. Scalp wounds bleed a lot,
but they are usually not a problem. Please do not panic, and
do not rush into the emergency department demanding immediate
assistance. We'll talk more next week. Write me in care of
the Yated.
A message from Glaxo, sponsor of this column.
Pulmonary hypertension is a difficult disease to handle, and
many medications that we try are only marginally effective.
Flolan from Glaxo is the only medication of its kind approved
in Israel to help this malady. There is hope with Flolan.
