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?
When someone has a bleed in or around the brain, there is only a short amount of time before pressure starts to build up within the skull. I don't blame Natasha, or the Canadian healthcare system. As terrible as it sounds, when I read about how she complained of a headache a hour or so later, I had a feeling about what the final result was and would be.
I just had a patient who stroked and required TPA, he developed a massive bleed. By the time he got to me, got FFP and was placed on medication to lower his BP because the SBP was in the 200s, he was probably already beginning to herniate. His pupils were nonreactive and he responded to no stimuli. He was made comfort care that morning.
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?
I haven't followed the specifics of her story, However I can tell you for working at Montreal General Hospital ( Level 1 Trauma center) ( McGill University Health Center,a renown University and Medical center) that they have an entire ICU devoted to head traumas and a great team of researchers and Neuro surgeons.The Montreal general's counterpart for the University of Montreal is the Hôpital du Sacré-Coeur (where she was transported I believe), a major Trauma center getting half of the major injuries occurring in the area as well as ALL the Northern Territories (which are all transported by helicopter or private medical jet!)
If they were allowed to treat her, they would have been able to provide the very best care to her. If she was beyond the point on non-return, even the best neuro surgeon cannot reverse Brain Death!
such a sad story. hopefully this tragedy will save other lives. does anyone know the particulars of the fall itself? i mean was it a wicked hit or what? i'm also not big on making a fuss and maybe she also felt embarrassed which of course is horribly misguided in hindsight. even as a nurse my first inclination might be to blow it off if i didn't feel particularly impaired at the time. not anymore. scary stuff.
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.
Why were you wearing a helmet while walking ??? :chuckle:
Sorry, but I had to ask!
Copied from an official report:"Ms Richardson was on a beginner slope taking a lesson-
Her fall seemed to be a minor one, and she was not only conscious afterward, but talking and joking. It was only an hour later, when she complained of severe head pain, that she was rushed to a local hospital, transferred to one in Montreal's Hospital (...)the fall on the ski slope on Tuesday might have simply aggravated a previous injury, or even have nothing to do with it at all."
So, for all we know, she could have had an brain aneurysm...
....about wearing helmets while skying.....
43 percent of all skiers and snowboarders surveyed in the United States wore helmets in the 2007-2008 season.Even so, the rate of accidental deaths on the slopes has not changed much.
The most recent review of helmet efficacy in ski accidents concludes that "the salutary effect [of helmet usage] was limited to the less serious head injuries, such as scalp lacerations and mild concussions." . "[No significant effect noted for the more serious head injuries such as concussions more severe than mild, closed head injury, skull fracture and death due to head injury.".
In other words, in the scenario that results in brain injury or death, you would need something more than a helmet to save you!
The NSAA (National Ski Area Association) wrote on their web page:
"Skiing and snowboarding are no more dangerous than other high-energy participation sports. The sport has some inherent risks, but overall the sport enjoys an excellent safety record (...)
In fact, the number of skiing or snowboarding fatalities (per million participants) is less than the number of fatalities from swimming or bicycling. (...) Indeed, you are twice as likely to die from being struck by lightning than suffer a fatality from skiing or snowboarding.
So I propose to all wear a helmet in case we slipped on a banana skin, and don't forget the isolation boots in case we were struck by lightning!
The only reason everyone is making such a big deal of this, is because it happened to a "star"....I have yet to see a thread about my friend's 2 little cousins killed by a drunk driver last week !
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.
I didnt even think of this part and believe you could be right about that. However, it just seems if you are her body guard (or whatever), seems like you would want to err on the side of caution. Still cant find any info on just how she fell. I imagine it was quite something for a ski instructor and patrol follow her back to her room... especially if she had security, ect...
I haven't followed the specifics of her story, However I can tell you for working at Montreal General Hospital ( Level 1 Trauma center) ( McGill University Health Center,a renown University and Medical center) that they have an entire ICU devoted to head traumas and a great team of researchers and Neuro surgeons.The Montreal general's counterpart for the University of Montreal is the Hôpital du Sacré-Coeur (where she was transported I believe), a major Trauma center getting half of the major injuries occurring in the area as well as ALL the Northern Territories (which are all transported by helicopter or private medical jet!)
If they were allowed to treat her, they would have been able to provide the very best care to her. If she was beyond the point on non-return, even the best neuro surgeon cannot reverse Brain Death!
Thanks for setting us straight on that. Thats what I initially thought but couldnt believe what I was reading. I think that was most likely the scenario that she had herniated before getting to Montreal. Why then do you think they took her in an ambulance and not medivac from the local hospital to the Montreal hospital?
So, for all we know, she could have had an brain aneurysm...
The only reason everyone is making such a big deal of this, is because it happened to a "star"....I have yet to see a thread about my friend's 2 little cousins killed by a drunk driver last week !
I know ppl suspected an aneurysm initially but I believe her autopsy stated that the cause of death was blunt trauma to the head and epidural bleed. No mention of an aneurysm?
And no, Im not making it a big deal because she is a star per say- I know for the MEDIA yes, but me, no, it could be any Joe blow and I would still be shocked thinking that could happen to me or one of my family... Its the fact that she felt FINE, a minor tumble on the bunny slope to like dead with in 4hours. THAT, my friend, is scary... I bet lots of ppl are getting CT scans today....
I initially suspected a bleed when I heard about her accident. It's a sad situation. You're damned if you do, damned if you don't. She was a great actress.
The past few days, it seems that every head injury has been admitted to ICU. Guess the doctors are erring on the side of caution.
I've been an R.E.M. fan since the beginning of their career, and distinctly remember Bill Berry's brain aneurysm in 1995. I have a friend whose 14-year-old son died from one the year before, and for a number of weeks, I wondered if that boy was the more fortunate of the two. If Bill was going to live out his days in a wheelchair with a feeding tube and diapers, I for one didn't want him to live, but he made a full recovery.
Why were you wearing a helmet while walking ??? :chuckle:
Sorry, but I had to ask!
Fair question. I was walking out of the aid room on my way to close the hill. The gutters just above the door leaked and there was always a big patch of boilerplate ice just in front of the door. I was carrying my equipment and trying to get out the door before it hit my skis. Before I knew it my feet went out from under me and the next thing I remember is waking up to all of the rest of the ski patrol standing around me. Given my propensity to hit my head on things (like cabinet doors) I probably should wear a helmet at all times.:lol_hitti
Speaking of repeated hits to the head there is some thought that people who have had multiple hits to their heads (like football players and well...me) have a higher incidence of a serious head injury with a minor mechanism of injury. Interesting isn't it?
Fair question. I was walking out of the aid room on my way to close the hill. The gutters just above the door leaked and there was always a big patch of boilerplate ice just in front of the door. I was carrying my equipment and trying to get out the door before it hit my skis. Before I knew it my feet went out from under me and the next thing I remember is waking up to all of the rest of the ski patrol standing around me. Given my propensity to hit my head on things (like cabinet doors) I probably should wear a helmet at all times.:lol_hitti
Speaking of repeated hits to the head there is some thought that people who have had multiple hits to their heads (like football players and well...me) have a higher incidence of a serious head injury with a minor mechanism of injury. Interesting isn't it?
Well! I'd say you have a good guardian angel! It was really fortunate you were still wearing that helmet when you fell!
In your case, I'd have to agree about wearing a helmet at all times! If you hit your head a lot because you are tall, i'd recommend the isolation boots as well....
I thought you were going to say that people who take repeated blow to the head had a propensity to loose a fair amount of neurons....I was referring to boxers of course,not to you
Following head trauma someone may not show any signs or sx of a bleed for a couple hours, by then ICP could have already been building and within 30 minutes or less of showing the first sx it could be too late.
Without knowing specifics it's hard to assume anything, but I had a gentleman that hit his head in the afternoon. Came to the ED complaining of a headache and a little bit of dizziness and nausea. It took about 45 minutes to get to CT, he had a huge bleed. Right after CT he started showing sx of decreased LOC and in about 10 minutes vitals were starting to go nuts with the increase in ICP. He herniated before he could get to OR and that was the end. So what I'm saying is, if she had a slight headache and nausea she probably thought it was from smacking her head since these are typical sx for a mild concussion and by the time she felt she needed to go to the ED it was almost too late already.
RN1982
3,362 Posts
When someone has a bleed in or around the brain, there is only a short amount of time before pressure starts to build up within the skull. I don't blame Natasha, or the Canadian healthcare system. As terrible as it sounds, when I read about how she complained of a headache a hour or so later, I had a feeling about what the final result was and would be.
I just had a patient who stroked and required TPA, he developed a massive bleed. By the time he got to me, got FFP and was placed on medication to lower his BP because the SBP was in the 200s, he was probably already beginning to herniate. His pupils were nonreactive and he responded to no stimuli. He was made comfort care that morning.