expand your brain --- literally.

In one of my classes, an instructor was sharing a real-life-crazy-ass story that left me thinking:

Are you freaking kidding me?!

Unfortunately, we didn't have time to have much of a discussion about it so months later I decided I'd do a little more of my own research.

This week's installment = decompressive craniectomy

Ok, so my fancy language probably doesn't mean much so I'll break it down a little.

You may be thinking how can I get one of those. Please don't. As it would likely involve suffering from traumatic brain injury (TBI).

This may be caused by:

• falls

• vehicle accidents

• violence

Severe strokes & brain tumors could also land you one.

One of the biggest issues with TBI is increasing intracranial pressure which can quickly become deadly. As the pressure increases, the brain may out grow the space of the skull & block off blood flow (& oxygen) to the brain.. BIIIIIIG PROBLEM.

Decompressive craniectomies involve taking off part of the skull to allow the brain to swell. YES. YOU. READ. THAT. RIGHT. This may involve CUTTING off (with a saw like tool) large parts of the skull.

Now get this: while the brain is expanding without a skull, doctors may surgically open the abdomen and put the piece(s) of skull in the abdomen between layers of muscle and fat so that it won't die (other options are freezing it) and can be reattached at a later time.

More details: the brain is covered with an artificial dura (layer of the brain) to help prevent infection but risk of infection is still significant.

Uh yeah, definitely used as a last resort.

------- Flat Lining -------

Your television shows are lying to you.

Enter the very common scene: A patient is heading south/circling the drain. They're in an ER department, hooked up to an EKG machine when all of a sudden they flat-line. Immediately, the healthcare workers grab the defibrillator & shock the patient where they magically come back to life.

THIS IS A LIE.
[but giving drugs to a patient in this situation would be boring to watch]


"Flat-lining" is medically referred to as asystole. The heart in this state has NO electrical output. Normally electrical output tells the heart how hard and when to beat. We have backup systems if one conduction path fails but in certain situations [e.g., severe heart attack (MI), large amounts of potassium (hyperkalemia), massive clot to the lungs (pulmonary embolus), stroke, suffocation, narcotic overdoses] things can go awry.

In order for a defibrillator to work, there must be SOME electrical activity. Most commonly, patients whose hearts go into the dangerous rhythm ventricular fibrillation (v. fib) will get shocked.

As for aystole, patients need CPR stat. Drugs like epinephrine and atropine are also crucial.

And now you know. Don't believe everything you hear/see.


[normal sinus rhythm: the heart rhythm of most healthy people]