Primer On Severe Brain Injury on TBILAW

Thanks for having made it to the primer on
severe brain injury at I’m Gordon Johnson and I’m going to tell you a little
bit about what our goals are on this primer on severe brain injury. We’re first going to cover some basic definitions
of things about the diagnosis that you probably been given by the neurosurgeon. There are
two really critical things for you to understand when dealing with the questions of brain bleeds
and hemorrhage. The first is that blood is a toxic element to brain tissue if it’s not
inside a blood vessel. It’s not where it’s supposed to be. The second is anytime you have a brain bleed,
or if even a significant hematoma or swelling, what happens is that the brain becomes compressed
by the additional amount of fluid that is contained within the skull. We have a model and this is something we use
in the courtroom from time to time and I had different, several different kinds, and I
also have a foam rubber model of the brain. To start in terms of understanding brain bleeds,
hemorrhage and brain swelling, we should probably take the top off of our model. This one is
plastic. If we were talking more about specific other issues, I’d probably use an actual human
skull but showing but this is a plastic skull and we can quite easily take the top off. You can see inside of here is an actual representation
of a human brain. What’s different about this brain that I contain here and the one I have
in my hand is that this is a very firm, hard object. You don’t see any shimmer. In this
brain, you do see the shimmer and that will be more important when we talk about rotational
injury and axonal injuries. But this brain is actually much closer to the consistency
of an actual human brain. The key thing to understand when you’re talking
about bleeds, brain pressure events, is that the skull has a certain amount of volume.
It’s, it’s like a football or a basketball. It can only take so much air, or perhaps even
a car tire, can only take so much air. Ultimately if you put too much air in the tire, it’ll
blow up. If you put too much blood inside of the skull, if there’s a bleed in the brain
and the heart keeps pumping more and more fluid into the brain but there’s no release
of that pressure, so there’s no way to get it out. There gets to be more and more pressure
and ultimately that pressure is what causes the most serious damage in most severe brain
injuries. As there are more and more fluids, more and more blood accumulates inside the
skull, what happens is the smallest blood vessels, the capillaries, get compressed.
There may be enough power in the heart to push blood through the major blood vessels,
but the smaller the blood vessels are the more (vulnerable to that loss of) pressure,
that compression of the brain mass because there’s only so much movement inside the skull.
The compression of that brain mass cuts off the blood flow to those smallest vessels and
when blood vessels and blood flow doesn’t get to those small blood vessels major areas
of brain will begin to die. The reason it dies is that it doesn’t get
fresh oxygen; it doesn’t get fresh glucose which is the brain’s fuel and more significantly
the toxic waste products that is created with this chemical reaction – the little tiny fire
that runs the brain – those fumes, those toxic byproducts of the chemical reaction don’t
get removed and then the brain becomes a very toxic environment and ultimately dies.

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