Delicious foods you should be eating to keep your brain running smoothly
Just like your car needs oil to run smoothly, your brain needs certain nutrients and foods to stay in tip-top shape.
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As I drove to work after a night of wintery mix coating the streets and sidewalks, I was anticipating a high volume of patients who had slipped and fallen in the icy conditions.
It had been a very busy week with a high volume of patients with flu-like illnesses and many who were sick enough to require hospitalization. The city had gone on “citywide diversion” several times because so many of the hospitals and emergency departments (EDs) were packed with patients — those who were already admitted and waiting for a bed and those still waiting to be seen in the ED.
A citywide diversion is a process whereby EMS agencies are directed to transport noncritical patients to emergency departments in a predetermined capacity ratio.
During these periods, unstable patients go to the nearest, most appropriate hospital, and patients needing specialty care or who were recently discharged go to their established facility.
The patients who are felt to be not unstable but seeking emergency care are then distributed amongst the various emergency departments in a predetermined ratio, as to not overburden one particular department.
When I arrived to work, we were not on citywide diversion for the first time in a few days. We had a only few admitted patients waiting in the ED to be admitted, and there were only a few people in line, checking in to the ED to be seen. Everything seemed to be a bit less chaotic, and we were ready for all the ice-related injuries.
Shortly after I arrived, Valerie, a very sweet elderly woman, arrived to the ED via ambulance from her home after she had taken her dogs out, when she slipped and fell on the icy steps on her back patio.
Thankfully she had left the backdoor open and her husband heard her yell for help once she realized she could not get up on her own. She wasn’t sure if she had momentarily blacked out, but she was certain she had only been laying on the ground for a few minutes before her husband came to assist her.
He carefully maneuvered the icy steps and went to her side and found her at the bottom of the two steps down from their patio to the yard. Valerie was having a lot of pain in her left hip and her left wrist, where she had fallen on her left side.
He tried to pull her up with her hands and she cried out in pain when he touched her left wrist. He helped her sit up just using her right arm and then went to get his phone to call 911.
When the paramedics arrived, they put a vacuum splint underneath Valerie and were able to then carry her to the ambulance cot. They did their assessment of Valerie and were concerned that she may have broken her hip and her wrist.
She was also complaining of a headache but said she had it before the fall and did not think it was related. To be cautious, they also put a collar on her neck to immobilize her neck in case of a neck injury. The paramedics placed an IV in Valerie’s arm and gave her pain medications as they were transporting her to the ED.
I was able to see Valerie shortly after she arrived at the ED, and after talking with her and performing a physical exam, I was very worried about her headache. I could see that she had broken her wrist and may have also broken her hip, but her headache really bothered me the most.
She said she had slipped and fallen on water on her kitchen floor over New Year’s. She said she didn’t lose consciousness with that fall and wasn’t sure she even hit her head that time.
She developed a headache around the same time and thought she had suffered from a sinus infection. She saw her family doctor and was treated with two rounds of antibiotics, but the headache persisted.
In addition to X-rays of her wrist and hip, I sent Valerie for a CT scan of her head and neck. I looked at the pictures as soon as they were available, and my suspicions were confirmed. Valerie had bleeding inside her skull that was causing compression on parts of her brain.
She had what is called a subdural hematoma, which is frequently the result of a sudden impact, like a fall, causing strain on the blood vessels which causes them to rip and bleed. The pressure of the bleeding on the surrounding areas of the brain can lead to serious neurological consequences and even death.
Valerie had evidence of older blood, which is dark in color, on a CT scan, which I suspect was from her previous fall as well an area of fresh blood (that appears white on a CT scan) that had occurred from the fall that brought her to me that morning.
Neurosurgery immediately came to see Valerie in the ED and recommended an emergent surgery to remove the blood from within her skull to relieve the pressure on her brain.
Without the surgery, they told Valerie and her husband she had a high likelihood of developing permanent neurological deficits or even death. Valerie had also broken her wrist, which we placed in a splint, and her hip was only bruised as all her imaging confirmed nothing was broken.
Valerie and her husband consented to the surgery, and she went directly to the operating room from the ED. Valerie spent the first night in the neurocritical care unit, where she was closely monitored.
Valerie’s surgery was very successful, and she had come through surgery with no neurological deficits. She recovered well over the next few days and was able to go home from the hospital with a home health nurse and physical therapy exercises.
Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth. She can be reached at: [email protected].
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