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Hartstein explains Schumi's treatment

Monday 30th December 2013

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Hartstein explains Schumi's treatment

Hartstein explains Schumi's treatment

Former F1 doctor Gary Hartstein took to Twitter on Sunday night to explain the medical implications of Michael Schumacher's injury.

According to reports in France, Schumacher suffered "cranial hemorrhaging" when he hit his head on a rock while skiing with his son on Sunday morning.

The 44-year-old remains in a coma in a Grenoble hospital after undergoing "immediate neurosurgical treatment" on a head trauma.

Hartstein, who was axed as F1's doctor in 2012, shared his medical knowledge on Schumacher's condition.

"It's quite well known that extradural hematomas, a kind of cerebral hemorrhage, can leave a lucid interval after injury," he wrote on Twitter, former_f1doc.

"Then as the hematoma forms, the sudden increase in pressure causes sudden and dramatic symptoms. Pressure must be relieved rapidly.

"This is done with a neurosurgical intervention. Then the victim is observed in an ICU environment.

"Quality of recovery depends on: 1) severity of initial injury 2) acuteness and amplitude of pressure rise when hematoma forms 3) rapidity with which it is drained 4) quality of neuro intensive care and rehab.

"About the "induced coma". Lets demystify it just a bit. Any severe head injury leads to a loss of coordination of tongue and throat muscles.

"Happens to some when they sleep - called SNORING. But this is respiratory obstruction and causes CO2 to rise and oxygen to fall.

"But the brain wants oxygen and hates CO2. So we put tubes in these patient's tracheas and use respirators. This protects the airway.

"And gives excellent control of ventilation and oxygenation. But to intubate someone, he or she needs to be pretty deeply anesthetised.

"So this is the usual "artificial coma". It IS a induced coma, but in fact it's like a prolonged, protective, anesthetic.

"So what's next? Simply put, providing the brain with the most normal conditions possible, while avoiding usual ICU threats.

"This means normal oxygenation and CO2 levels, normal blood flow. Normal blood sugar. Strictly avoiding fever. And any irritative seizures.

"Maintaining normal intracranial pressure. This is no doubt being monitored and can be acted on in a number of ways.

"In terms of avoiding complications, weaning from ventilatory support and intubation as soon as clinically possible is high on the list.

"Getting the patient fed fully, using the GI tract, is important too. Measures to avoid venous thrombosis/pulmonary embolism are standard."

The next update on Schumacher's condition is expected at 10am local time with Hartstein explaining that the timing gives Schumacher's doctors the opportunity to run more tests.

"Not surprising at all to wait to 1000h GMT. Gives docs a chance to do rounds, see new CT scans, check blood results. That is perfectly fine.

"What we want to hear is: 1) off or starting to come off the respirator. 2) intracranial pressure staying normal. If we hear this, we're ok.

"And obviously anything better is, well, better."

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