Q: When is a trauma not a trauma?
A: When it's not a trauma.
Sounds logical enough, right? Stay with me here...I'm about to prove that it isn't always so easy to figure out when you don't know the story.
In the midst of an otherwise slow morning, yet another "fall" was about to come in. Would it be another elderly person on blood thinners who lost the unending fight against gravity? Some idiot working on his roof in the rain? An unlucky arborist whose harness broke?
None of the above. It was a young woman found on the ground in a parking garage. Great...another one "found down". Whee, what fun.
Though she didn't have a mark on her head at all, she was certainly acting like she had a severe head injury. She was terribly confused and could barely keep her eyes open.
Uh oh, I thought. This was going to be bad.
Our physical examination only noted some scratches on her knees, and the bottoms of her feet were filthy. We rushed her off to the CT scanner where I expected to find a massive bleed.
I watched the scans of her brain as the pictures flipped by on the computer screen. But it soon became clear that she had nothing. NOTHING! Her brain (and the rest of her body) appeared completely normal.
As I sat there scratching my head (Maybe she just had a severe concussion? Diffuse axonal injury?), her sister arrived and told us the patient's name. Wait a second...I know that name! That's the same name as one of the ER docs at my other hospital! I looked closely at the patient...she was still fast asleep, but yes indeed, same person! And that's when I learned what had really happened.
She had just come off working the night shift in the emergency department. She got home and took two sleeping pills which happen to have a very well-described side effect of sleep walking. Her feet were so dirty because she had sleep walked out of her bedroom, out of her house, and all the way to her parking garage, where she had finally lain down to sleep next to her car. That's also why she couldn't keep her eyes open.
She woke up about an hour later, completely uninjured but embarrassed as hell. "I'm supposed to be where you're standing, not in the bed," she told me. I saw her several days later in her ER when she called me about a patient.
"Any more interesting walks?" I asked her.
She smiled at me sheepishly. "Nope," she said with a blush. "I flushed the rest of the pills down the toilet."