What Is Cerebral Venous Sinus Thrombosis?

Hello Rescuers!

I received an email from a RoyOnRescue friend who had suffered a head injury while playing a sport.  After being seen by the doctor he was diagnosed with Cerebral Venous Sinus Thrombosis or (CVST).  He had asked me if I would give my explanation of what it is and if it was something he should be worried about.  His doctor had exCSVTplained it but he was still a bit foggy regarding the diagnosis.  Well, after looking into it from the clinical perspective, I realized that it was a pretty big deal and in some cases may be fatal.  I researched multiple sources to gather credible information and when it all came down to brass tacks, I found that the Wikipedia explanation had done a pretty dog-gone good job of summarizing CSVT.  So, with all credit given to them for most of this article and a link back to their website, here it is.

I have personally responded and treated many different types of head injuries as a paramedic but had not researched this problem to this level.  Then, shortly after receiving this question, I read that  Secretary of State, Hillary Clinton was diagnosed and hospitalized with the very same problem secondary to her head injury!  Ironic.   So, I thought to myself, if two people experienced this problem secondary to a common traumatic head injury(concussion), there may be more with the same question.

Here’s my trimmed-down version of what it is, what it’s symptoms are, how to determine if it is truly CSVT and then what a person may want to do if they think they may be suffering from such a complication.  So let’s dig into some of the questions you may have!  P.S.  You’ll notice there are more links then usual in this article.  The topic is so complex and has so many different facets I thought it wise to allow you to do some of your own information mining and hope the links make it easier.

Q:  What is a cerebral venous sinus thrombosis anyway?

A:  A CVST is the presence of thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain. 

Q:  What causes a CVST?

A:  There can be many causes of CVST.  Here is a few I included:

Q:  How might I know if I have a CVST?

A: Headache that may worsen over the period of several days, but may also develop suddenly.  Strangely the headache may be the only symptom of cerebral venous sinus thrombosis.  Stroke, 40% of all patients have seizures, Common symptoms in the elderly with this condition are otherwise unexplained changes in mental status and a depressed level of consciousness.  The pressure around the brain may rise, causing papilledema (swelling of the optic disc) which may be experienced as visual problems.  In severely raised intracranial pressure, the level of consciousness is decreased, the blood pressure rises, the heart rate falls.  This is a common symptom found in closed head injuries which makes sense as the mechanism is very similar.

Q:  How will the doctor know if this is what I have?

A:  The most commonly used tests are computed tomography (CT) and magnetic resonance imaging (MRI), both using various types of radiocontrast to perform a venogram and  visualise the veins around the brain

Q:  How is a CVST treated and cured?

A: Treatment is with anticoagulants (medication that suppresses blood clotting), and rarely thrombolysis (enzymatic destruction of the blood clot). Given that there is usually an underlying cause for the disease, tests may be performed to look for these. The disease may be complicated by raised intracranial pressure, which may warrant surgical intervention such as the placement of a shunt.

AmbulanceQ:  Can this be serious?

A:  Yes.  Like any illness or injury that causes a problem with the circulation of oxygenated blood to our tissues, this type of problem can be very dangerous if left untreated.  It also runs a risk of complication in that it raises the intracranial pressures which can act similar to a closed head injury and this too can cause severe injury or death.  If a person has any of the symptoms listed above, they should be seen as soon as possible to rule out this potentially life threatening disorder.  If a person is reacting with decreased level of consciousness, or any type of life threatening complications, activation of Emergency Medical Services or 911 should be immediate with life saving or time buying intervention given.

 

I hope this helps and keep well!

See Source:

http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosis

http://neurology.jwatch.org/cgi/content/full/2007/515/2

http://www.medscape.com/viewarticle/705510_3

 

 

Could You Survive Stranded In A Snow Storm?

After hearing about a couple getting stranded in a mountain pass off-roading and the driver dying while seeking help, I thought I should talk about key elements around surviving out in the cold.  People are often overcome by the cold simply due to lack of pre-planning, proper equipment and an adequate plan for survival until rescue help arrives.  If you’ve ever wondered what you would do if you were lost, stranded or overcome by the winter elements, be sure to watch this episode of RoyOnRescue.
In the meantime, remember at least these important points:

1.   Let people know where you are going and what route you’ll be taking…then stick to it!
2.   Dress with layers of clothing or have extra clothing available
3.   Bring warming agents like hand and pocket warmers along with extra blankets
4.   Bring extra food that can handle getting cold or even freezing like granola, nuts etc.
5.   Eat snow for hydration
6.   Bring GPS
7.   Bring Flare Gun
8.   Never drive with low gas tank
9.   If the roads are dangerous, maybe stay home or extend your vacation
10. Repeat steps 1 thru 9

Peace,

Roy, RoyOnRescue.com

What’s All The Fuss About The CPR Numbers?

In this episode of RoyOnRescue we take a look at the different numbers related to CPR over the years. There can be confusion when it comes to deciding what set of numbers are best for the best outcome. Watch this episode to learn the scoop on how CPR numbers may not be as important as some may think they are.

Best Wishes,

RoyOnRescue Team

Dangers Of The Rescue Scene

In this episode, I take a moment to talk about the recent traumatic death of an EMT who was struck by a vehicle while working with a patient on the scene of an accident. No matter if you’re a professional or a good samaritan, scene safety is the utmost important factor to keep in mind. It’s terrible that this EMT was killed in the line of duty trying to save lives and help people. I hope this RoyOnRescue helps to sharpen everyone’s level of awareness regarding safe scenes and how to rescue without becoming a patient yourself.

Ankles, Impaled Objects and CPR

In this episode of RoyOnRescue, I answer two different emailed questions. The first from Michael who asked: “I was taught you remove the object only if it interferes with CPR.” Great question Mike. As a general rule of EMS, we only remove an impaled object if it’s obstructing the airway and preventing the ability to secure an airway. Removing an impaled object will often times “un-plug: the hole that was created by the injury and may cause excessive internal bleeding that can only be controlled in a surgical environment. As a lay rescuer, the Good Samaritan will follow the directions of the 911 dispatcher. In a worse case scenario, hands only CPR can still be performed. If the object is in the chest, try and work around the object as best as possible and provide what care you can without causing more harm. A second question came in just this afternoon from Sara who asks about an “ankle popping out” and what to do if this were to happen while on vacation. It sounds as though Sara may have a chronic problem with her knee or ankle but because of a recent injury is especially concerned that it could happen while on an exciting vacation this Friday. In both cases I hope that the advice I give helps and a little tidbit about the first aid acronym, RICES could be the solution while on vacation. Watch this episode to learn more about what to do in case either of these situations arise.

Happy Thanksgiving!

Roy, RoyOnRescue

Can I Choke A Patient With A Pulse Check?

In this video, Roy takes a moment to explain a training that he includes in his CPR videos where he checks for a carotid pulse on one side of the patients neck and then the other without moving from one side to the other physically.  Some students have asked if this is wrong, as they were taught to NEVER reach over the patients neck while checking a pulse. They were told that they could crush the patients trachea or even choke the patient! For Roy’s answer, you’ll want to watch this video.
Peace,
RoyOnRescue Team

Trick or Trauma! Tips for a safe All Hallowed Eve.

Trick and Treating can be a very fun way to celebrate Halloween but it can also pose some dangers.  In this special Halloween episode I wanted to quickly cover a few tips on how to protect our children and ourselves this Halloween.  Be sure to check out this episode to freshen up on some easy ways to ensure a lot more treats than tricks or trauma.

Happy Halloween!

Roy

 

When I Was Doing CPR The Patient Began To Revive…But I Heard They Didn’t Make It. What Gives?

I received a really good email from a rescuer who provided CPR to a person and before the emergency services arrived, the patient was exhibiting signs of revival.  Later, the rescuer discovered that the patient did not survive after all.  This person had a valid question about how or why this would happen and I wanted to include my reply so that it may help others who may in the future or  have already had the same experience.

Dear “Rescuer”,

There are so many reasons why a person may start to revive or does revive from initial cardiac arrest only to arrest again later and die. This fact that he later died should in no way be connected to your heroic actions you performed. By getting involved you increased his chance of survival by attempting to circulate some percentage of oxygenated blood to his vital organs in order to slow down the clinical to biological death process.

Of course, we never want to think that our rescue efforts will not change the end result. But in expressing compassion, you gave this individual one of the greatest gifts one can give, your care, compassion and your love for a fellow human.

Whomever that gentleman was, for a certain amount of time, you were able to give him the care he needed in order to have a chance to survive. Statistics and data show us this to be true. This does not mean however, that his condition would allow him to survive for the long term. The cardiac related disease that he may have suffered from chronically, the pulmonary embolism that may have occluded a vital vessel in the circulatory system or any other serious medical problem could have still determined that he was not going to survive his cardiac event.

Your efforts were completely successful because they did exactly what CPR is suppose to do… buy time! Be at peace knowing that you were successful in that you did buy him time and your efforts were not in vain. His last hours of life were spent knowing that someone he didn’t even know intimately cared enough to try and save his life. That’s an incredible gift to give someone.

I hope that this in some way can help bring you comfort.

Peace,

Roy

Email Questions and Answers Part 1

Hello Everyone!

In this episode of RoyOnRescue, Roy takes some time to catch up on different emailed questions and comments that have come in over the last few months.  The two different emailed questions that were answered were; “won’t laying a person down while choking only make it worse?” and “I thought we were always suppose to control arterial bleeding before beginning cpr!”.   Roy takes his time to discuss these two different topics and explain the reasons why we do what we do in rescue in detail.

Be sure to join Roy in Part 1 of several parts as he works his way through a list of different topics that have been sent in by viewers like you.

Remember,  If you’ve got a question or comment that you would like Roy to answer or give  a response, please send it via email to:  royonrescue@gmail.com.  Be sure to follow Roy on twitter at:  @royonrescue

Remember, your actions make a bigger difference than you realize and you can change the course of history.

Keep On Rescuing,

The RoyOnRescue Team

Heat Wave!

Hello Everyone!

In this RoyOnRescue Video blog, Roy takes a look at the record breaking heat that most of the Country has been experiencing and gives a few tips on recognition and treatment of heat related emergencies like; heat exhaustion, heat stroke, dehydration, electrolyte problems etc.  So learn what to do, and how to survive the severe summer heat.  Don’t miss this episode of RoyOnRescue!

P.S.  Below, I’ve included some really clear signs and symptoms of heat related injuries, compliments of WebMD.  Click on the WebMD link for more information.

 

What Are the Symptoms of Heat-Related Illnesses?

Heat cramp symptoms include:

  • Severe, sometimes disabling, cramps that typically begin suddenly in the hands, calves, or feet
  • Hard, tense muscles

Heat exhaustion symptoms include:

Recommended Related to First Aid

  • Fatigue
  • Nausea
  • Headaches
  • Excessive thirst
  • Muscle aches and cramps
  • Weakness
  • Confusion or anxiety
  • Drenching sweats, often accompanied by cold, clammy skin.
  • Slowed or weakened heartbeat.
  • Dizziness
  • Fainting
  • Agitation

Heat exhaustion requires immediate attention but is not usually life-threatening.

Heat stroke symptoms include:

  • Nausea and vomiting
  • Headache
  • Dizziness or vertigo
  • Fatigue
  • Hot, flushed, dry skin
  • Rapid heart rate
  • Decreased sweating
  • Shortness of breath
  • Decreased urination
  • Blood in urine or stool
  • Increased body temperature (104 to 106 degrees)
  • Confusion, delirium, or loss of consciousness
  • Convulsions

Heat stroke can occur suddenly, without any symptoms of heat exhaustion. If a person is experiencing symptoms of heat exhaustion or heat stroke, GET MEDICAL CARE IMMEDIATELY. Any delay could be fatal. Seek emergency medical care for anyone who has been in the heat and who has the following symptoms:

  • Confusion, anxiety, or loss of consciousness
  • Very rapid or dramatically slowed heartbeat
  • Rapid rise in body temperature that reaches 104 to 106 degrees Fahrenheit
  • Either drenching sweats accompanied by cold, clammy skin (which may indicate heat exhaustion); or a marked decrease in sweating accompanied by hot, flushed, dry skin (which may indicate heat stroke)
  • Convulsions
  • Any other heat-related symptom that is not alleviated by moving to a shady or air-conditioned area and administering fluids and salts