Wanted to ask you neuro nurses (& Canadian nurses) to maybe shed some light on the matter?
1) Does anyone know the treatment she received in Montreal? such as emergency surgery?
2) Her condition upon arrival? Did she arrive in time for emergency intervention or had she herniated at that point?
3) How does one go from walking off a bunny slope to brain dead in 24hrs or less? I could understand if there were circumstances that delayed her arrival to a hospital but it seems she got there in decent time?
Specializes in NICU, PICU, PCVICU and peds oncology.
Mortality rates from epidural hemorrhage range from 5-43% (US data, 2008). There are a number of blogs discussing this case and the consensus is that this tragedy could just as easily have happened anywhere. Reasons? Malpractice costs reduce the number of neurosurgeons willing to even take emergency call, never mind perform delicate surgeries in small community hospitals. Time is of the essence with epidural hemorrhage because even a small amount of bleeding will tip over the Monroe-Kellie applecart, and any time a person with epidural bleeding refuses medical care, they're risking their lives. Would the availability of a helicopter have made a difference? Maybe, but unless the helicopter was based close to the site of the accident, there would have been dispatch time added to the actual transport time, so that is perhaps a red herring. It's scary to think that there but for the grace of God, go I.
Specializes in NICU, PICU, PCVICU and peds oncology.
According to the most recent new report, she wasn't actually declared brain dead until she was already at Lenox Hill, hours before they terminated life-sustaining treatment. So she wasn't transported after determination of brain death was conferred. I notice there was no mention of organ donation... But I don't think we should open that can of worms... (madly stuffing worms back into the can)
I believe she went via private jet from Montreal to NY. I was surprised they flew someone with a severe TBI in a private jet, but I guess if she was already brain dead it's a moot point.
Yes, I was so shocked when I heard about this. I am keeping her family in my thoughts.
There seem to be a lot of skiing accident. Shouldn't all ski facilities have a helmet law as well as a manditory law that you have to be seen by medical personnel if there is a suspected brain injury? I know patients have the right to refuse medical treatment but I do not know if the general public quite understands that they can feel fine one minute and be critical the next if they have suffered a brain injury.
I notice there was no mention of organ donation... But I don't think we should open that can of worms... (madly stuffing worms back into the can)
I had wondered about that, but like everything else, making this public is ultimately the family's decision. It's always possible that she wasn't a candidate, for whatever reason, or did not want to do this, and the family and medical staff must respect these wishes if that was indeed the case.
What if she HAD sought help earlier, and ended up in a PVS or worse yet, fully conscious and apparently lucid but unable to take care of herself?
Yes, I was so shocked when I heard about this. I am keeping her family in my thoughts.
There seem to be a lot of skiing accident. Shouldn't all ski facilities have a helmet law as well as a manditory law that you have to be seen by medical personnel if there is a suspected brain injury? I know patients have the right to refuse medical treatment but I do not know if the general public quite understands that they can feel fine one minute and be critical the next if they have suffered a brain injury.
The general public is suffering from INHTM syndrome. That is "It'll Never Happen to Me". I can't tell you the number of times in my 29 years as a patroller I have explained the risks of head injuries to stubborn adults and even more stubborn parents who refuse our care, transport to a hospital or even an hours observation in the aid room. They simply do not believe that it will happen to them or their child. We've tried being nice, being mean, getting law-enforcement involved, ugly pictures, detailed discharge instructions, threats of wearing diapers the rest of their lives, death of themselves or their child, intervention by family members but it doesn't matter. The American public does not want to be told what to do. The harder you try the harder they dig in their heels. A helmet law will never pass and no ski resort is going to enforce the wearing of helmets because it will affect their bottom line. It's unfortunate but true. I know for a fact that my helmet saved my life when I slipped on ice and fell WALKING. The helmet didn't survive but I did.
Specializes in NICU, PICU, PCVICU and peds oncology.
I know patients have the right to refuse medical treatment but I do not know if the general public quite understands that they can feel fine one minute and be critical the next if they have suffered a brain injury.
I'm betting that they do now!
What if she HAD sought help earlier, and ended up in a PVS or worse yet, fully conscious and apparently lucid but unable to take care of herself?
Yeah, that would be even more troublesome I think, but most people don't like to see things from that perspective.
I would really like to learn something from this. I have not dealt with anyone with increased intracranial pressure, as I am a new grad. From what I have been reading, the symptoms could include: Headache, blurred vision, behavior change including lethargy, decreased level of consciousness, seizures, and vomiting.
My question is, if one of my kids fell and hit his head, which of these symptoms would I most likely see first? Would it be the headache, and then within the hour some of these other ones? While transporting, I would assume a High Fowlers position would be best, but I may be wrong. What else could I do until EMT arrived or I was able to get my kid to the ER?
I know patients have the right to refuse medical treatment but I do not know if the general public quite understands that they can feel fine one minute and be critical the next if they have suffered a brain injury.
THAT is where the paramedics, ski patrol come in and educate those who DONT know this and insist she be seen. Even if not just for the paramedics to hang out with her, investigate the situation. Of course I realize people can refuse care, but dont walk away so quickly! Educate. I know some are being sensitive that their Canadian health care is under attack or people pointing fingers but the fact of the matter is: We should LEARN from this. Thats it. Like the QA meetings doctors have speaking of cases and how to make things BETTER. Im sure Im not the only one who is surprised this area of Canada does not have medical helicoptors or that neurosurgeons arent as readily available as in the US. We are under health care reform. Canada has universal health care, OF COURSE ITS GOING TO COME UP. So lets get over our toes (your toes, whoever's toes) being stepped on and lets just learn from this, okay? People have questions and they are valid ones, nothing wrong with that. I think we are smart enough to know that it 'wont bring her back'. We are all nurses here, so that was unecessary to say.
Specializes in acute rehab, med surg, LTC, peds, home c.
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.
I work in rehab and we occassionally get pts that fall, go to the er and are sent home even after having a ct scan. The problem doesn't show up right away sometimes. The person could have a slow bleed that takes days or even up to 2 weeks to show up. Usually with a subdural hematoma they can do burr holes into the skull to relieve the pressure by evacuating the blood. Not sure if they treat epidural hematoma the same way. I think epidural is worse because its arterial bleeding. They often present just like a cva or TBI. I guess in her case it got bad quickly but when she was checked out in the er it wasn't bad enough to show up or for her to have symptoms yet. I can totally see how something like this could happen and it is really nobodies fault, just one of those fluky things. Such a terrible shame. My kids and I loved her in Parent Trap. I wonder how old her boys are.
SHE made the decision not to be transported to the hospital initially, and she signed a waiver, from what I understand from an early article I read on Yahoo. You can educate until you are blue in the face, but if someone isn't going to listen, they are not going to listen. Bottom line.
And add to the fact that she was no common Jane....probably had a personal assistant or two, security, etc. following her around, and their job is to keep her away from the 'common' folk and keep her from being 'bothered' by them. They well could have gotten in the way of any education efforts by the EMT's to 'protect' her from being 'harrassed'. No one who works for those powerful people would dare speak up and say "Wow, I think you're being really dumb. Go to the hospital, already," and risk losing their jobs. So sad.
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NeosynephRN
564 Posts
I suspose if said persons family was willing to pay for transport and admission to a new facitily then.....
It is a tragedy, no matter what happened.
We had a brain bleed a couple weeks ago, started the transport process while in MRI....still took over 5 hours....YIKES!!!