Oh, Christmas Tree

An ER visit after decorating a Christmas tree.
By Marven Ewen, MD
Medical Director
It was the Christmas holiday season. A time of good cheer, festivities and, unfortunately, holiday-related accidents.

Rudolf, a 32-year-old accountant, had just arrived home late at night from his office Christmas party, filled with Christmas cheer and spiked eggnog. He stood unsteadily in his living room and admired the huge Christmas tree he was able to bring home this year, a bonus from his work. He decided to finish decorating it and surprise his wife.

He still had to place the angel on the top of the 8-foot spruce. Not having a ladder readily available, he rolled his office chair from his den to the tree. He could just reach the top of the tree standing on the chair.  When he reached over the girth of the tree to place the figure, the chair rolled and he lost his balance falling onto the tree, and then striking his head on the window ledge, before landing on the hardwood floor.

His wife was awoken by the crash and found him unconscious on the floor. EMS was called.

On arrival, the patient was alert but complained of a headache and seemed to have some slurred speech. His breath had an odor of alcohol. He refused to go to the hospital. The EMTs insisted and notified law enforcement. The patient was transported to the ER.

On assessment at the hospital, the CT of his c-spine was normal, but the CT of his head showed an epidural hematoma. An epidural hematoma is a collection of blood in the epidural space, between the dura mater and the skull.

It is more common in young men and represents 2% of all head injuries, but up to 15% of all mortality related to head trauma. The reason for epidural hematoma being more common in young people is that as we age, the dura becomes more adherent to the skull and less of a potential space for blood to accumulate. Subdural hematomas (bleeding between brain and dura mater), on the other hand, are 3 times more common in the elderly due to brain shrinkage stretching bridging veins, making them more prone to rupture.

Neurosurgery was consulted and our patient underwent emergency surgery to evacuate the hematoma. A common presentation of epidural hematoma is loss of consciousness on impact with a transient period of alertness before deteriorating into unconsciousness and death. The EMTs in this case made the right decision to transport even though the patient wanted to stay home. He lived to see another Christmas thanks to their diligence.

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