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- Hey guys, this is Dr. Carl Baird at Evolve Performance Healthcare.

Today we're gonna talk about what you need to do to recover from an injury sustained

in a car accident here in Portland, Oregon.

The first thing to do, is to open a PIP claim.

So what PIP stands for it's Personal Injury Protection.

It's part of your auto insurance policy and it covers you for up to 100% of medical expenses

after a car accident and so a couple things to keep in mind with this is one, again, it's

through your auto insurance policy, so this isn't health insurance and two, even if you

weren't at fault in the accident you open it up through your own auto insurance policy

and then they'll seek reimbursement from the at fault party.

So, it doesn't raise your rates, they get reimbursed 100% but just keep in mind you

have to open it through your own auto insurance policy.

Now, the second thing to do is to schedule an appointment with a medical provider whether

that be an MD, a chiropractor, or a PT.

This is important for two reasons.

The first being that studies have shown that people who receive care early on after a car

accident experience greater long-term results in terms of pain and disfunction after a car

accident.

So, it's really important to get in there early as you all know a lot of times in a

car accident the pain doesn't come on right away.

It's the two to three days later and the second reason we wanna get in early is again, it

has to do with the insurance which as a healthcare provider we are advocate to get the necessary

care and the longer we have in between when the car accident happened and that initial

intake, the harder it is for us to advocate that these injuries were sustained in the

car accident and not caused by something else which is again what the insurance company

wants to prove.

So again, it's really important to get in early and the third is to receive care.

So again, there's a lot of different types of care that help the body heal.

Here at Evolve Performance Healthcare, what we focus on is full body chiropractic care,

manual therapy and rehabilitation with the goal of again, reducing pain quickly and effectively,

two, restoring range of motion, and more importantly, is building that strength and stability to

prevent long-term complications from a car accident.

So there you have it.

Those are the three things you need to do if you're involved in a car accident here

in Oregon and we're happy to help if you go ahead and follow the link down below, or give

us a call, 503-954-2495.

Thanks for watchin'.

For more infomation >> Back Pain Treatment After a Car Accident | Accident Clinic in NE Portland - Duration: 2:23.

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Subdural Hemorrhage - causes, symptoms, diagnosis, treatment, pathology - Duration: 8:56.

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Subdural hemorrhage can be broken down.

Sub means below, "dural" which refers to the outermost protective layer of the brain,

which is called dura mater, and "hemorrhage" refers to bleeding.

So, a subdural hemorrhage is when there's bleeding below the dura mater.

OK - let's start with some basic brain anatomy.

The brain is protected by 3 thin layers of tissue called the meninges which covers the

brain and spinal cord.

The inner layer of the meninges is the pia mater, the middle layer is the arachnoid mater,

and the outer layer is the dura mater.

The pia and arachnoid maters, are also called leptomeninges.

Between the leptomeninges, there's the subarachnoid space, which houses cerebrospinal fluid, or

CSF.

CSF is a clear, watery liquid which is pumped around the spinal cord and brain, cushioning

them from impact and bathing them in nutrients.

The outer membrane, the dura mater consists of two layers.

The internal layer of the dura mater lies above the arachnoid mater - the two are separated

by the subdural space.

The external layer of the dura mater adheres to the inner surface of the skull.

These two layers of the dura mater travel together, but at certain spots, the internal

layer of the dura mater separates from the external one to form the meningeal folds.

The meningeal folds help divide the sections of the brain like the falx cerebri which separates

the two hemispheres of the cerebrum, and the tentorium, which covers the cerebellum and

separates it from the cerebrum.

The subdural space plays a major role in venous

blood drainage in the brain.

The surface of the brain is supplied by numerous arteries in the subarachnoid space that provides

oxygen rich blood to the brain.

After the brain tissue has taken up the oxygen and nutrients, the blood drains into superficial

cerebral veins, or bridging veins, that also sit in the subarachnoid space.

These veins travel through the arachnoid mater, pass through the subdural space and penetrate

the inner layer of the dura mater to drain into the dural venous sinuses located between

the two layers of the dura mater.

Eventually the blood in the venous sinuses drain into the internal jugular vein and returns

to the heart.

So, the main cause of a subdural hemorrhage is a rupture of the bridging veins located

in the subdural space.

When a blood vessel is damaged and there's active bleeding, it's called a hemorrhage,

and the collection of blood that results is called a hematoma.

Some people, like the elderly often have brain atrophy where their brain shrinks in size,

and that means that the bridging veins are stretched across a wider space where they

are largely unsupported - a bit like a long rickety bridge across a mountain pass.

In infants and in individuals that abuse alcohol the veins are thin walled, and therefore more

likely to break.

Subdural hematomas are common in head traumas like falling in a wet bathtub and whacking

your head or in shaken baby syndrome where a baby is violently shaken, making their head

whip back and forth damaging the bridging veins.

Subdural hematomas can also occur after an acceleration-deceleration injury like speeding

on the road and then suddenly slamming the brakes.

When that happens, the seatbelt will stop the body and head from moving forwards but

the momentum will carry the brain forward where it impacts the front of the skull.

Right after that, the head moves backwards and hits the headrest causing the brain to

impact the back of the skull.

That rapid back and forth movement once again causes damage to the bridging veins.

Regardless of the mechanism, once a bridging vein is torn, the blood pools in the subdural

space creating a hematoma.

Since the damaged bridging veins are under low pressure, the bleeding can be slow causing

delayed onset of symptoms which might develop over the course of days to weeks as the hematoma

gradually expands.

So an acute subdural hematomas causes symptoms within 2 days, a subacute subdural hematoma

causes symptoms between 3 and 14 days, and a chronic subdural hematomas causes symptoms

after 15 days.

The hematoma can compress the brain and cause increased intracranial pressure.

A large subdural hematoma on one side of the skull can cause a midline shift which is a

displacement of the whole brain towards the opposite side of the skull.

The increased intracranial pressure can also cause the brain to herniate.

There can be a supratentorial herniation where the cerebrum is pushed against the skull or

the tentorium, and an infratentorial herniation where the cerebellum is pushed against the

brainstem.

Both of these can be lethal.

Supratentorial herniations can compress the arteries that nourish the brain leading to

an ischemic stroke and infratentorial herniations can compress the vital area in the brainstem

that control consciousness, respiration, and heart rate.

The most common symptoms of a subdural hemorrhage are loss of consciousness right after the

injury or in the ensuing days to weeks as the hematoma increases in size.

Other symptoms include headaches and vomiting.

Sometimes there can be focal neurological symptoms like muscle weakness or sensory problems

based on the location of the hematoma.

Diagnosis of a subdural hemorrhage is typically done with an imaging study.

On a CT scan, an acute subdural hematoma shows up as a hyperdense mass meaning that it looks

"more white" than the surrounding healthy brain tissue, whereas a chronic subdural hematoma

shows up as a hypodense masses which is "less white" than the surrounding brain tissue.

An "acute on chronic" bleeding is a combination of hyperdense and hypodense, which is seen

in individuals who have a rebleed in the bridging veins after a chronic hematoma has already

formed.

The blood in a subdural hemorrhage is between the inner and outer layers of the dura mater.

So on a CT scan, subdural hematomas follow the contour of the brain and form a crescent-shape

and cross suture lines.

In contrast, epidural hemorrhages cause blood to build up between the outer layer of the

dura mater and the skull.

Since the outer layer of the dura mater adheres tightly to the skull at sutures, epidural

hematomas don't cross suture lines and they push on the brain forming a biconvex shape.

Small subdural hematomas are drained by placing a small tube called catheter, through a drilled

hole in the skull.

Large subdural hematomas require a craniotomy, which is when part of the skull bone is removed

in order to remove accumulated blood below.

Alright, as a quick recap.

A subdural hemorrhage is a bleeding below the dura mater, caused by the rupture of the

bridging veins found within the subdural space.

Subdural hemorrhages are common in trauma, and in some groups, like the elderly, babies,

and individuals that abuse alcohol.

On a CT scan, an acute subdural hemorrhage forms a hyperdense blood collection, whereas

a chronic subdural hemorrhage forms a hypodense blood collection.

Subdural hematomas cross suture lines and follow the contour of the brain forming a

crescent-shape, unlike epidural hematomas which don't cross suture lines and push

on the brain forming a biconvex shape.

For more infomation >> Subdural Hemorrhage - causes, symptoms, diagnosis, treatment, pathology - Duration: 8:56.

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Sleep apnea - Obstructive Sleep Apnea (OSA) in Children: Symptoms, diagnosis and treatment - Duration: 7:01.

Sleep Apnoea in Children:Symptoms, diagnosis and importance of early treatment

What is Sleep Apnoea

pause and breathing for about 10 seconds that's what to sleep apnea is defined as

really it's an obstruction in the air flow to the lungs and hence the oxygen

supply to the brain so there's a pause and breathing for a few seconds but this

could be happening for lots of episodes of sleep apnea could be happening during

the nights during the child's sleep here so if it's happening a lot of times

that's a lot of oxygen deprivation to the brain and we know the brain cells

they die off that's true people think sleep apnoea only happens to fat

people that's not true it's there in children and I'm sure you

talked to some of the teachers and schools and they'll be able to tell you

this children that are they're not doing so well not able to pay attention may be

disruptive in the classes and when you look at those children then you often

just see that there are mouth breathing children they've read too many faces ask

a few more questions those moms will tell you those kids are all moving all

around the bed they're tired in the morning or as they're running around

with too much energy and they're tired later on and they they're not able to

pay attention and they don't do well in School

What are the early signs of sleep apnoea in children that parents need to look for?

teeth grinding the mouth open at night , recurrent infections, chesty coughs: you may notice your child's

bedwetting or they might be waking up with nightmares quite regularly that's

another indication because that's when the brain is really getting disturbed

because of the lack of oxygen and maybe they're not doing so well in school or

they're not able to pay attention but sleep apnoea is a big problem today and

it can be happening in your child and you may not know that

Should I be concerned if my child or somebody in my family snores?

it's not a normal thing to be happening really if patients are having disturbed

sleep or the snoring is an indicator that airflow may not be efficient to the

lungs and hence the oxygen supply again to the brain if the oxygen supply isn't

efficient then of course brain cells are going to be affected here and this has

been shown and the MRI scans now that their areas in the brain are actually

obliterated and especially memory cells

modern research now is telling us a little bit more that these children with

ADHD in fact it may be not really a disease but just more of a symptom of

breathing disorders at nighttime and their behavior has changed and of course

they're unlabeled as possibly on a spectrum when in fact

it might only be actually a sleep disorder they have their Airways were

developed as a younger age they may not have any problems and we are seeing that

as well. because when there isn't efficient oxygen supply to the brain the

brain is a very greedy organ it needs it so initially it's going to instruct the

cerebellum area to start you know let's get the heart rate going up and the

blood pressure will rise and the adrenal glands will start producing more

adrenaline we're starting to get more sugar supply the diabetes is another

factor that's that's going to be playing into any disturbance in and breathing at

nighttime so chronic illnesses then you know irritable bowel and Crohn's disease

other things have been mentioned we still can't prove everything here but

certainly all these patients that tend to have sleep apnoea are more prone to

stroke for instance snoring we know creates plaque buildup in the carotid

artery and these plaque buildups as you know can easily just fly off and

cause someone to have a stroke

when we see children with

their mouth open, the problem with mouth open is that

we're not getting the tongue up into the roof of the mouth to guide the face to

grow forwards so what happens then is the structure is growing in a negative

way the lower jaw is beginning to fall down and roll backwards we got to

realize we have to have enough room in their mouth for all the teeths that we

are designed to have which is 32 teeth later on we also need room for our

tongue and as soon as the face is growing downwards and backwards the

tongue doesn't have enough room in there later on so it's sitting further back in

the airway and as soon as it starts to sit further back in the airway it has a

negative effect an airflow into the lungs and the child may find that

they're struggling for air at night it may move around the bed at night they

possibly could have sleep apnea if the tongue is obstructing air flow at all

even for a few seconds our brain needs oxygen all the time if it's not getting

it there is going to be problems

so if we have a tube you know a breathing tube here in the throat this

is the collapsible part of the airway now it's slightly supported at the fact

that the whole front of it is collapsible and if you're not working

those muscles and there are many muscles that I'm talking about in this whole

area between the chin this hyoid bone and right down to the clavicle or the

collarbone and the breastbone or the sternum if you're not working those

muscles and they're all the ones we work in myofunctional therapy you're going to

end up with flaccid or flabby muscles and that's where you have your apneas

the super important thing about treating children early enough is that you can

guide a face to grow forward to get the jaws further forward improve the size of

the airway and as soon as the airway is bigger they're breathing better they're

sleeping better, they're standing better they're looking better