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Posts Tagged ‘traumatic brain injuries’

I read with concerns about Swenson Tan, 22, who lapsed into a coma three weeks ago after being hit by a van. He was declared brain dead by doctors at Changi General Hospital (CGH) on Friday (Mar 8), but his traumatised parents refused to accept the outcome. The full-time national serviceman, who had studied Mechanical Engineering at Ngee Ann Polytechnic, was riding a motorcycle near Hougang Ave 7 when he collided with a van. He suffered serious head injuries and underwent a six-hour operation. (link)

What bothers me is that there are reports of many accident victims who were declared as brain-dead by doctors woke just in time before their life support system were removed.  In 2012, a 17-yr old Steven Thorpe’s parents refused to give up hope – despite four specialists declaring that the 17-year-old was brain dead and wanted to switch off his life support machine. He woke up after a 2-week coma (link).  I thought about it and remember that in 2012 that was an experiment that showed that severed nerves could repair itself quickly in a calcium-free environment.  (link)

This appear to me that it is about time for our doctors here in Singapore to try this on accident or trauma patients with brain injuries, meaning when the accident patients  first admit to the emergency ward, they should be exposed to as little calcium as possible.  This will allow the important nerves in the brain to quickly heal themselves.  Maybe earlier some brain-dead patients who recovered were those who were on heart medication that on calcium-channel blocker medication.  In fact there were some experiment done on this in 2003.

Calcium channel blockers for acute traumatic brain injury. (link)
Langham J, Goldfrad C, Teasdale G, Shaw D, Rowan K.
Source : Clinical Effectiveness Unit, Royal College of Surgeons of England, 35 – 43 Lincoln’s Inn Fields, London, UK, WC2A 3PN. Abstract
BACKGROUND:
Acute traumatic brain injury is a major cause of death and disability. Calcium channel blockers (calcium antagonists) have been used in an attempt to prevent cerebral vasospasm after injury, maintain blood flow to the brain, and so prevent further damage.
OBJECTIVES:
To estimate the effects of calcium channel blockers in patients with acute traumatic brain injury, and in a subgroup of brain injury patients with traumatic subarachnoid haemorrhage.
SELECTION CRITERIA:
Randomised controlled trials in patients with all levels of severity of clinically diagnosed acute traumatic brain injury.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently assessed the identified studies for eligibility and extracted data from each study. Summary odds ratios were calculated using the Mantel-Haenszel method.
MAIN RESULTS:
Six RCTs were identified as eligible for inclusion in the systematic review. The effect of calcium channel blockers on the risk of death was reported in five of the RCTs. The pooled odds ratio (OR) for the five studies was 0.91 (95% confidence interval [95%CI] 0.70-1.17). For the four RCTs that reported death and severe disability (unfavourable outcome), the pooled odds ratio was 0.85 (95%CI 0.68-1.07). In the two RCTs which reported the risk of death in a subgroup of traumatic subarachnoid haemorrhage patients, the pooled odds ratio was 0.59 (95%CI 0.37-0.94). Three RCTs reported death and severe disability as an outcome in this subgroup, and the pooled odds ratio was 0.67 (95%CI 0.46-0.98).
REVIEWER’S CONCLUSIONS:
This systematic review of randomised controlled trials of calcium channel blockers in acute traumatic head injury patients shows that considerable uncertainty remains over their effects. The effect of nimodipine in a subgroup of brain injury patients with subarachnoid haemorrhage shows a beneficial effect, though the increase in adverse reactions suffered by the intervention group may mean that the drug is harmful for some patients. (link)

Comments:  The 2003 experiment were on “acute traumatic brain injury” meaning those patients were still alive and not brain-dead.  Maybe their experiment totally missed the entire point, which is, to ascertain whether a traumatic patient would not become brain-dead if calcium channel blocker medication were rendered immediately  together in a calcium-free environment for the patient to survive pass the brain dead stage and help immediate nerve repairs as demonstrated in the 2012 rats experiments.  Our doctors here should keep abreast with latest developments, especially in traumatic brain  injuries that is so common among the motorcyclists.  Here one motorcyclists dies every two days.  The ministry of health should publish data whether most of the organs harvested were from these pools of dead motorcyclists and whether if our brain-dead procedure should be revamped for progress and ethics reasons.

Take Care

Mikey

cc:  Dr Goh Siang Hiong and Dr Chua Hoe Chin (both my dear secondary four classmates who went on to become good and dedicated doctors in the A&E and Neuro Recovery departments)

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