Question for ER, Cardiac or other physicians

[SteelBlue]

Watching the Mcgahee injury today I saw that he was posturing immediately after being hit. I'd say it was decorticate posturing. I've always associated that with a serious head injury because of all the patients I've worked with in rehab who demonstrate it for days and days after the injury. But thinking back, I've seen this several times over the years in football games. I remember Don Bebee of the Bills looking like he was decerebrately posturing and the guy was playing again a couple weeks later. Am I not seeing what I think I'm seeing, or am I just wrong to always associate the posturing with serious head injury. Serious meaning life altering.

[Rx GATOS]

He's probably just looking for a way to get vicodin like the rest of the world.

[ERCougar]

You're right about what posturing means, but he wasn't posturing last night. The confusion may arise because decorticate posturing would be similar to the position they would place someone in to transport them, i.e. to get them on and off the backboard. Not sure about Bebee as I don't recall that play, but I'd be shocked if he were posturing either. It's not the type of thing that would happen after a football injury--at least I've never heard of a case. It would take a pretty serious direct blow to the head. The last case I saw was a few months ago and it was a helmetless kid who was thrown from a motorcycle about 40 feet when it hit a ditch, and in that case, with blood all over in his brain, the posturing was still pretty subtle. He's alive, but barely functional now. That's even an exception--typically, if you're posturing in an acute setting, you're not gonna make it.

EDIT: As I think about it, I can't think of a single case of someone fully decorticate posturing immediately after an injury. The only cases of full decorticate posturing I've seen were in the ICU as a resident and were, like you say, days out from the initial injury.

[UtahDan]

I don't really know what you guys are talking about, but as I was watching the whole thing the only thing that really caught my eye was after they had him on the back board and right before they put him on the cart he was laying flat calmly and and suddenly both arms came up off his chest as though he was suddenly startled or thought he was going to be hit, almost defensively. I think we have all done that in our sleep (or at least I know I have) but having just taken a big shot to the head I thought, that can't be good. Does that mean anything to either of you?

[SteelBlue]

You're right about what posturing means, but he wasn't posturing last night. The confusion may arise because decorticate posturing would be similar to the position they would place someone in to transport them, i.e. to get them on and off the backboard. Not sure about Bebee as I don't recall that play, but I'd be shocked if he were posturing either. It's not the type of thing that would happen after a football injury--at least I've never heard of a case. It would take a pretty serious direct blow to the head. The last case I saw was a few months ago and it was a helmetless kid who was thrown from a motorcycle about 40 feet when it hit a ditch, and in that case, with blood all over in his brain, the posturing was still pretty subtle. He's alive, but barely functional now. That's even an exception--typically, if you're posturing in an acute setting, you're not gonna make it.

EDIT: As I think about it, I can't think of a single case of someone fully decorticate posturing immediately after an injury. The only cases of full decorticate posturing I've seen were in the ICU as a resident and were, like you say, days out from the initial injury.

This makes sense. It seems if it was actually posturing the injury would be very severe. But look at what I'm seeing in the video. It happens way before they carry him out. It's happening as he hits the ground, way before the trainers are even out there to help him. Here's the clip (you get a great view of it at the minute mark):

[YOUTUBE]c1ssVchGUm0[/YOUTUBE]

Both arms go into flexion, and player seems to be unconscious. What am I seeing there if not posturing? Also, regarding your edit, those are the people that I'm working with all the time. It's days/weeks out and they have survived but posturing can still be quite severe.

[ERCougar]

This makes sense. It seems if it was actually posturing the injury would be very severe. But look at what I'm seeing in the video. It happens way before they carry him out. It's happening as he hits the ground, way before the trainers are even out there to help him. Here's the clip (you get a great view of it at the minute mark):

[YOUTUBE]c1ssVchGUm0[/YOUTUBE]

Both arms go into flexion, and player seems to be unconscious. What am I seeing there if not posturing? Also, regarding your edit, those are the people that I'm working with all the time. It's days/weeks out and they have survived but posturing can still be quite severe.

I'm not sure what he's doing, but you'll notice that his legs are flexed, which wouldn't be consistent with posturing. I suspect he's just reflexively curled after a big hit. If he were posturing, even if only subtle, he wouldn't be talking today, as you know.

Regarding the patients you work with every day, you probably know more about the intricacies of posturing than I do, but in my experience, it tends to be a phenomenon that develops over hours to days, not immediately. Like I said earlier, most cases are subtle when I see them but then become more severe as the free radicals of reperfusion go to work destroying brain cells. I honestly can only think of one example of someone who came into the ER fully posturing.

[ERCougar]

I don't really know what you guys are talking about, but as I was watching the whole thing the only thing that really caught my eye was after they had him on the back board and right before they put him on the cart he was laying flat calmly and and suddenly both arms came up off his chest as though he was suddenly startled or thought he was going to be hit, almost defensively. I think we have all done that in our sleep (or at least I know I have) but having just taken a big shot to the head I thought, that can't be good. Does that mean anything to either of you?

Hmm...no idea. It is an eerie feeling being transported on a backboard, so it's not unusual for people to jump and startle, but I'm not sure what to make of what you're describing. I didn't notice it, and neither did my friend who was watching it with me (also a physician).

[SteelBlue]

Thanks ER, this is something I've been wondering about for a while as I've seen it a few times over the years in football and UFC. But then, as you said, they are talking the next day. I could never reconcile it with what I see at work.

[Tim]

I'd say it was decorticate posturing.

Can you explain what you mean by "posturing"? When I read that, I see it as you saying that he's "faking it," but I don't think that's what you mean. How about a medical lesson for us less-knowledgeable folk?

[ERCougar]

Can you explain what you mean by "posturing"? When I read that, I see it as you saying that he's "faking it," but I don't think that's what you mean. How about a medical lesson for us less-knowledgeable folk?

It's a specific medical term, completely unrelated to the common usage of the term. Basically, it's a specific position (actually there are two described) that the body assumes with severe brain injury.

[CardiacCoug]

Can you explain what you mean by "posturing"? When I read that, I see it as you saying that he's "faking it," but I don't think that's what you mean. How about a medical lesson for us less-knowledgeable folk?

[HuskyFreeNorthwest]

Hmm...no idea. It is an eerie feeling being transported on a backboard

It was much worse mentally than physically, I hope I never go through that again.

[ERCougar]

It was much worse mentally than physically, I hope I never go through that again.

What happened?

[wuapinmon]

My dad died of (confirmed, sporadic) Creutzfeldt-Jakob Disease. He lay like this the entire last month of his life, and if you made any moderate to loud sudden noise he would startle like you had set off a string of firecrackers in his bed. It was gruesome to watch.