An enjoyable family vacation turns into a nightmare. But it keeps my job interesting…

A family of four rented bikes to ride around the lake…no helmets, but hey, it’s totally flat, and what can go wrong? Mom’s bike slips off the side of the paved pathway, drops a few inches onto the dirt and she falls over, hitting her shoulder on the ground. She got up and they went into a local store nearby where an appropriately concerned bystander drives them to the hospital while dad goes back to retrieve the family car.

Between the time she entered the doors of the emergency room in a wheelchair and I had finished my initial assessment, she went from “Ouch my shoulder hurts,” to being completely inappropriate and incomprehensible.

Had she hit her head? THey didn’t think so. Was she wearing a helmet? No. Did she get knocked out? No, she was just a little confused at first.

I ordered the head CT, but before we could even call the tech, she siezed.

I intubated her after doing a repeated neurologic exam after the siezure ended. At that moment, I had x-ray vision. She had absolutely not a single scratch on the outside of her body and yet I could see through her skull and watch the middle meningeal artery continue to bleed, putting pressure on her brain. ‘Something is terribly wrong,’ she had said to us at one point just prior to siezing.

She was right. A stat CT confirmed my suspicion, the helicopter came to take her down the hill and I updated the trauma surgeon at the accepting end of the line.

Please, please, please, ALWAYS wear your helmet!