Body
Story
Crash:
Intervention
•
David's case: haematoma
•
Laura's case: ruptured spleen
The
body has a remarkable ability to heal
itself. But sometimes it needs help.
•
David's case: haematoma
For
instance, a large haematoma that compresses or shifts the brain may damage
structures in the brain stem, threatening the areas that control breathing
and the heartbeat. A haematoma may also raise the pressure inside the
skull, eventually cutting off the blood supply to the brain. In such cases
there is nothing the brain can do to save itself. If the individual is
to survive, surgeons must intervene to remove the clot.
But
how do doctors know that a blood clot is threatening a patient's life?
Respiratory difficulties and cardiac arrest may indicate a blood clot,
but they may indicate a number of other problems. However, there is one
revealing symptom: if one of the pupils is dilated, this may indicate
that pressure on the brain is crushing the nerves in the eye. This is
what happens in David's case.
Clearing
a brain haematoma
Once doctors have shaved the patient's scalp, there will be a tell-tale
bruise indicating the area where the bleeding is occurring. Mannitol,
a drug used to reverse acute brain swelling, is injected into the blood
stream to draw fluid out of the blood vessels and relieve the pressure
on the brain.
Doctors
must then drill a series of small holes in the skull and remove the area
of bone in between the holes. Through this gap, they will be able to clear
the clot, relieving the pressure on the suffocating brain cells. Although
the extent of the damage caused by a haematoma may still be severe, surgery
removes the immediate threat to life.
•
Laura's case: ruptured spleen
In the case of a ruptured spleen, the brain takes the wrong action when
it tries to repair the damage. Suddenly deprived of blood, it instructs
the heart to beat faster in order to increase blood flow. But the blood
simply pours out of the ruptured organ, reducing the blood supply to the
brain even further. In such a case immediate surgery is needed to keep
the patient alive.
Finding
the wound
Laura's abdomen is opened. She is bleeding out very rapidly, and her brain
is kept alive only by the external supply of blood being pumped into her
system. The surgeon has only moments to find the rupture, and with blood
gushing from Laura's system, this is no easy task. He has to find the
wound by touch.
Once
the wound has been found and the artery clamped, the effect is immediate:
blood flows back to the patient's brain within seconds. Laura's life is
no longer threatened.
The
surgeon has then to make a choice: to perform a splenectomy removal of
the spleen or to repair the spleen, which is a more risky operation.
Splenectomy
The removal of the spleen is not an overly complex operation, and patients
may spend as little as a week in hospital. But the aftermath of splenectomy
is with the patient for life.
Removing
the spleen weakens the immune system, making the patient vulnerable to
infections, which can be serious if not dealt with quickly. Long-term
antibiotics must be prescribed.
One
post-splenectomy patient, whose sons have also had to have their spleens
removed as a result of disease, describes life without a spleen: 'We all
live without symptoms, but we are all prone to infections, we sleep to
excess and have enormous trouble waking in the morning. This is to the
point that we just don't function until late morning and feel like we
have hangovers.'
Repairing
the spleen
Repairing the spleen is therefore preferable in the longer term, though
there are risks of further rupture. The surgeon must remove the damaged
part of the spleen, sew up the rest of the organ and remove the clamp
from the artery. If the new seal on the spleen holds, the operation will
have been a success.
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