Jason's Brain Injuries.
https://www.google.ie/search?q=diag...Dql5bLAhWDhSwKHQEQC4EQsAQIGw&biw=1366&bih=667 these are some diagrammatic sketches of the brain showing layers.
From Autopsy-AD The right frontal, bilateral parietal, left occipital, and left temporal scalp has confluent, pinkcontusion/ecchymosis. On the right side of the forehead is a 1 x 1", raised, purple ecchymosis withoverlying 7/8 x 3/4", irregular, superficial, red-brown abrasion and 3/4", linear, superficial, redabrasion. On the right temporal region is a 1 1/2 x 3/8", irregular, superficial, red abrasion. On theright parietal scalp is a 3 1/2 x 2 5/8" coarsely stellate, complex, branched, full-thickness, lacerationwith partial avulsion. The branches individually range from 1/2" to 2" in length. There is underminingaround the wound up to 1" in depth. The edges have abrasion and tissue bridging is evident. Skullfractures are visible in the depths of the wound. Inferior to this wound, on the right parietal-occipitalscalp, is a 1 1/4", linear, vertically oriented, partial-thickness laceration with tissue bridging andminimal undermining. On the right occipital scalp is a 1/4 x 3/16", irregular, superficial, red abrasion.On the left frontal hairline is a 1", curvilinear, superficial, red abrasion with a background of pinkcontusion. In the left frontal scalp is a 2", curvilinear, full-thickness laceration with two superficial,1/2", jagged extensions; it has undermining of up to 1" on its lateral side. Just lateral to this fullthickness laceration is a 1/2" jagged, partial-thickness laceration. On the left parietal scalp is a 6 1/2 x4" coarsely stellate, complex, branched, full-thickness laceration with partial avulsion. The branchesindividually range from 3/4" to 2" in length. Anteriorly, it has is undermining to a length of 2";posteriorly, there is undermining to a length of 1 7/8". The laceration has extensive tissue bridging. Onthe left temporal scalp is a 2 1/4", curvilinear, full-thickness laceration with slight marginal abrasionand with evident tissue bridging. It has inferior undermining to a depth of 3/4". On the left occipitalPage 2 of 8 F201507355 26 August 2015 17:55region is a 1 x 3/4", irregular, superficial, red abrasion.The inferior right orbit has a 2 x 1 1/2" area of raised, purple ecchymosis. Within, overlying the inferiororbital ridge, is a 1/2", curvilinear, superficial, laceration. Also, there is a 3/4 x 3/8", irregular,superficial, red-orange abrasion. The nasal bones are palpably fractured. No other facial fractures arepalpable. On the right side of the bridge of the nose is a 1/2 x 1/2", irregular, purple contusion, withinwhich is a 1/2 x 3/16", irregular, superficial, red abrasion. On the tip of the nose is a 5/8 x 3/8",irregular, purple contusion.
The above are the external , visible or palpable injuries, any of which can cause internal injuries and fatal injuries.
INTERNAL INJURIES TO BRAIN- from autopsy- In each temporal region, the dura is peeled from the skull and there is a thin film of epidural
hemorrhage. Also, there is a thick film of diffuse subdural hemorrhage. Thick subarachnoid
hemorrhage is on each lateral cerebral hemisphere and there is diffuse, thin basilar subarachnoid
hemorrhage. The cerebellar hemispheres have patchy, irregular, focally thick subarachnoid
hemorrhage.
The ventral frontal lobes have patchy, irregular, contusions measuring up to 1/2" in greatest
Page 3 of 8 F201507355 26 August 2015 17:55
dimension. The ventral temporal lobes have extensive, discontinuous and confluent, purple contusions
covering a 3 x 2" area on the right and a 4 x 1 1/2" area on the left; the contusions are denser on the
left than the right. The cerebral cortical contusions are evident on sectioning, but the white matter is
uniform and without hemorrhage.
I did a search under terms traumatic brain injury causing death.. I was really looking for an injury that would cause immediate death
http://emedicine.medscape.com/article/1680207-overview-Traumatic brain injury (TBI) can be classified into static and dynamic injuries, depending on the rate with which force is loaded to the head. Static injuries occur over longer time periodsusually greater than 200 milliseconds (msec)and cause crushing head injury. Crushing head injuries are relatively rare and are caused when a massive weight crushes the stationary head and results in comminuted fractures of the calvarium, facial skeleton, and skull base, with fracture contusions and fracture lacerations of the brain.
Because the dura is attached to the skull, differential movement between the skull and the brain may strain and tear bridging veins to the point of failure and cause bleeding into the subdural space. The inertial movement of the brain is maximal in the cortex but extends into the brain with greater forces. It is this inertial movement of the brain that results in traumatic diffuse axonal injury
http://www.academia.edu/4121493/pro...een_meningeal_hemorrhage_and_skull_fracture(I was unable to copy paste the relevant sections from this article but its not overlong and does make reference to court protocols
http://www.cdemcurriculum.org/ssm/neurologic/ich/ich.php this explores different types of brain haemorrhage
Classically, patients with epidural hematomas have a brief loss of consciousness after their injury, followed by a lucid period. Then, they lose consciousness again and deteriorate into herniation and death. You might hear this described as the 'talk and die' phenomenon. In reality, most EDH patients either do not lose consciousness, or do not regain it-NNBB
Subdural hematomas have a wide clinical spectrum. Acute SDH is more common in younger patients with a history of trauma. Rapid accumulation of extra-axial blood, the absence of pre-existing atrophy, and the presence of other traumatic brain injuries correspond to a worse neurologic status at presentation. As the younger brain is less atrophic, even small volumes of extra-axial blood can increase ICP and result in severe deficits.
From same article-
Initial Actions and Primary Survey
A patient with any type of intracranial hemorrhage may present with coma, rapidly declining level of consciousness, or seizure. In such cases, the priority is the ABCD's.
Secure the Airway if there are concerns about oxygenation, ventilation, airway protection, prolonged seizure, or rapidly deteriorating clinical status. A neuroprotective rapid-sequence intubation protocol is preferred.
Proceed with a brief assessment of Breathing, Circulation, and Disability while the patient is being preoxygenated, and intubation equipment and drugs are prepared. Neurosurgeons often find the documentation of a pre-intubation neurological exam to be helpful in determining prognosis. At minimum, such an assessment should include documentation of the Glasgow Coma Score, the pupillary size and reactivity, and motor strength in the four limbs. Sensation and reflexes can be included if time permits.
Make sure to check a fingerstick glucose before intubating.
It is a vast science.. and there is far more to be learnt here and much better references.
I undertook the search out of curiosity on whether Jason was dead when the EMT call was made.
I have not drawn a definite conclusion but the reading and my experience suggests he was either comatose or dead.
Also his skull and brain were X-rayed following and during the autopsy. we do not have the result of that Xray available to us. Its possible that bone fragments were lodged within or depressing vital to life functions as well.
I do apologise for my layout, I am lousy at computer skills.. if anybody wants to tidy it up to make it more reader friendly, and add more links that would be great.
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