Natasha Richardson's TBI and demise

rhon91 · Mar 19, 2009

Just heard official autopsy report per CNN: Epidural hematoma :::looking up:::

labcat01, BSN, RN · Mar 20, 2009

I don't know much of the specifics but she probably had head trauma followed by a lucid interval- where she probably appeared fine and then rapidly decilned (you can read a good summary on wikipedia http://en.wikipedia.org/wiki/Lucid_interval).

After that, your guess is as good as mine. I don't know how her condition was once she got to the hospital or what they did for her- I doubt the hospital will be releasing the specifics. Very tragic and sad

rhon91 · Mar 20, 2009

I don't know much of the specifics but she probably had head trauma followed by a lucid interval- where she probably appeared fine and then rapidly decilned (you can read a good summary on wikipedia http://en.wikipedia.org/wiki/Lucid_interval).
After that, your guess is as good as mine. I don't know how her condition was once she got to the hospital or what they did for her- I doubt the hospital will be releasing the specifics. Very tragic and sad

Thanks for the link. Ive been reading some information but dont know the validity of it, such as Montreal not even having a medical helicopter, thus she went by ambulance from resort to 1st hosp, got CT, then sent to Montreal hospital. Some say the Canadian health system lack specialists, such as a neuro-surgeons, compared to the US... Still trying to understand why a common injury thats treatable wasnt treated? I mean what percentage of your patients in a neuro ICUs are SDH with ventrics?

TheCommuter, BSN, RN · Mar 20, 2009

I was watching CNN yesterday, where it was reported that she was already brain-dead by the time she left the Canadian hospital.

Her husband reportedly decided to have her transported to New York so her two young sons could have a chance to say goodbye before the plug was pulled.

rhon91 · Mar 20, 2009

I was watching CNN yesterday, where it was reported that she was already brain-dead by the time she left the Canadian hospital.
Her husband reportedly decided to have her transported to New York so her two young sons could have a chance to say goodbye before the plug was pulled.

Yes, I got that part-that she was brain-dead prior to being flown to NY. What remains to be revealed is was she brain-dead upon arrival to the MONTREAL hospital- where they could have done surgery to relieve the pressure and control bleeding? I am reading that there is no medical helicopter there. She went by ambulance from resort to 1st hospital 25mi away, CT scanned, then via ambulance to Montreal hospital 60mi away... Seems like I even saw somewhere where she wasnt even admitted to the Montreal hosp until TUESDAY when her accident was Monday afternoon.

Diahni · Mar 20, 2009

Greetings:

Does anyone work with people who have brain injuries? I would like to know about this sad and untimely death. I have read Ms. Richardson didn't get to a hospital for four hours. Yet her fall, they're assuming, caused a ruptured artery. How would the hospital staff deal with this? The injury was described in this article, along with the admonition to wear a helmet.

http://latimesblogs.latimes.com/booster_shots/2009/03/richardsons-inj.html

Thanks,

Diahni

Pediatric Critical Care Columnist · Mar 20, 2009

I've merged two threads since they're both discussing the same topic.

Pediatric Critical Care Columnist · Mar 20, 2009

First let's not forget that EMS cannot force a person who is competent to make decisions accept emergency care. They could not have tossed her into an ambulance and rushed her off to a hospital against her will... and she refused medical treatment initially. By the time her headache became bothersome, it was likely already too late to do anything.

The fact that the province of Quebec does not have a shock-trauma air rescue service may well have been a contributing factor. But how different would the outcome have been had the accident happened across the border in Vermont, where I have been unable to find any evidence of a STARS program? Killington is 80 miles (1 hour 41 minutes by road) from Burlington, where the majority of Vermont's neurosurgical and critical care expertise is centered; Jay Peak is 65 miles away (1 hour 55 minutes by road) and Stowe is 36 miles away (47 minutes by road). So just because this happened in Canada means that it's Canada's fault.

We have the same population as California, about 30 million, spread out over the second largest country by landmass in the world. How many neurosurgeons do we need? Mont Tremblant and Ste Agathe, the town where Ms Richardson was taekn initially, have populations of about 9000 permanent residents... how many towns of that size in the US have CT scanners and neurosurgical services on site?

This is a tragic incident that should provide a cautionary tale for all of us. But bashing Canada isn't going to bring her back.

Pepper The Cat, BSN, RN · Mar 20, 2009

Thank you janfrn - you make a lot of valid points.

One of the first things that came to my mind after hearing about this accident, was wondering how quickly American would try to blame the Canadian health care system.

From what I understand, Natasha refused to go to the hospital, even when recommonded by the ski patrol. By the time symptoms were showing, damage had probably occured. We will never know what the outcome would have been, had she had a CT scan right away but chances are the injury would have been caught in the earlier stages.

WalkieTalkie, RN · Mar 20, 2009

I've seen stuff like this a lot, and epidural hematomas are quite possibly one of the worst brain injuries. The person will often feel fine and then within hours their ICP is sky high.

People don't realize that TBIs occur all the time. Most of the time the patient is transported immediately, but sometimes they initially feel fine but start showing symptoms later. For example, a lot of elderly people will fall and hit their head, think nothing of it, but later come in with a head bleed because they were on coumadin. If I recall correctly, isn't an epidural hematoma one of the most rare types of closed head injury?

There is a lot of finger pointing going on, but nobody is really at fault here. If a patient refuses transport, how can people blame the ski resort, the paramedics, etc?

What I want to know, is how was a patient who was already brain dead transported to another hospital? I guess Canadian hospitals don't follow EMTALA... I mean was she transferred to a higher level of care or what? I can't imagine that anyone would transfer a patient with confirmed brain death.

Batman24 · Mar 20, 2009

She refused to go to the hospital. They can't force her. Damage was done by the time she got there. Hopefully this serves as a caution for everyone to wear helmets even on the bunny slope as accidents happen there as well. And if you take a blow to the head pls get emergency care. Better to be safe than sorry.

I was so terribly sad to read about her accident and death. My thoughts and prayers are with her family at this tragic time. God bless them all.