Perhaps no story impacting brain injury has impacted the public’s consciousness more than that of Natasha Richardson. I could write on this from dozens of angles and perhaps will in the coming months. The best news story (as opposed to commentary) on her injury and subsequent death is at the below link on the Global Mail website:
http://www.theglobeandmail.com/servlet/story/RTGAM.20090327.wrichardson0327/BNStory/National/
What is clearer in this piece than in the others is how the life threatening delay in her treatment occurred. This happened because people who should have known better, allowed someone suspected of having a concussion, make the critical errors with respect to her medical care. It is a theme I have echoed since the first days of http://tbilaw.com in 1996. One cannot rely on the memory and/or judgment of someone who has been concussed.
If Natasha had been put in a helicopter when her symptoms started to progress in that first hour after brain injury, odds are she would be alive today. The type of brain injury that killed her is the type we have made the most advances in treating because it is the kind of brain injury for which surgery makes a difference.
When I and my co-author, Becca Martin were writing http://waiting.com in the winter of 1997, we had a dedicated nurse from Froedtert Hospital in Milwaukee, Wisconsin assisting us, Denise M. Lemke, RN. I asked her what she believed to be the most important advance in medical science to help brain injured, expecting her to say the CT or MRI. What she said then was “the helicopter.” As with Natasha, the flight for life is the true miracle, because it allows doctors to work their magic while there is still a chance to eliminate the true killer, intracranial pressure.
Attorney Gordon Johnson
http://subtlebraininjury.com
http://thelegaltimes.net
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2009
Guidelines for Coma Management
One of the most difficult challenges in being a brain injury attorney and an advocate, is struggling with what to tell people when they call up and their loved one is in a coma. The Brain Injury Law Group is here to a significant degree, because that was one of the challenges we faced when we first started doing web advocacy. We created http://waiting.com in 1997, with a sense of urgency to help those who were waiting for word as to whether their loved one would ever awake. The story of our frustration with the Brain Injury Association’s refusal to accept our offer of help to create such a page, and our decision to do it ourselves, is well explained on that page.
The Brain Trauma foundation is an organization which shares a similar advocacy to help those in a coma, and I received this email from them today, covering the guidelines to assist medical professionals dealing with coma patients. To get to those links, click here: http://www.guideline.gov/whatsnew/newthisweek.aspx#date
What these new guidelines don’t call for, which I believe they should, is the use of funtional imaging, such as PET scans or fMRI to tell the degree to which there is sufficient brain function going on in the comatose person, to predict any reasonable chance of recovery. Coma guidance from doctors is far too much “we will just have to wait and see” and most times, from a very pessimistic outlook. I believe that PET scans and fMRI should be routinely used to give guidance to the family, when they are trying to make that awful decision as to whether there is enough chance of a satisfactory recovery, to keep trying to save the life of the comatose person. We always counsel prayer and inner searching. But when there are tools out there that could be used to provide more meaningful information on what is going on inside of that skull, we believe they should be used. I have instructed the person who is my health care power of attorney to demand that I have a functional imaging test if I am ever in that situation, and there is no valid reason why doctors don’t do the same.
They Brain Trauma Association has guidelines on the following:
Anesthetics, analgesics, and sedatives.
Antiseizure prophylaxis.
Blood pressure and oxygenation.
Brain oxygen monitoring and thresholds.
Cerebral perfusion thresholds.
Deep vein thrombosis prophylaxis.
Hyperosmolar therapy.
Hyperventilation.
Indications for intracranial pressure monitoring.
Infection prophylaxis
Intracranial pressure thresholds.
Nutrition.
Prophylactic hypothermia.
Steroids.
The Brain Trauma foundation is an organization which shares a similar advocacy to help those in a coma, and I received this email from them today, covering the guidelines to assist medical professionals dealing with coma patients. To get to those links, click here: http://www.guideline.gov/whatsnew/newthisweek.aspx#date
What these new guidelines don’t call for, which I believe they should, is the use of funtional imaging, such as PET scans or fMRI to tell the degree to which there is sufficient brain function going on in the comatose person, to predict any reasonable chance of recovery. Coma guidance from doctors is far too much “we will just have to wait and see” and most times, from a very pessimistic outlook. I believe that PET scans and fMRI should be routinely used to give guidance to the family, when they are trying to make that awful decision as to whether there is enough chance of a satisfactory recovery, to keep trying to save the life of the comatose person. We always counsel prayer and inner searching. But when there are tools out there that could be used to provide more meaningful information on what is going on inside of that skull, we believe they should be used. I have instructed the person who is my health care power of attorney to demand that I have a functional imaging test if I am ever in that situation, and there is no valid reason why doctors don’t do the same.
They Brain Trauma Association has guidelines on the following:
Anesthetics, analgesics, and sedatives.
Antiseizure prophylaxis.
Blood pressure and oxygenation.
Brain oxygen monitoring and thresholds.
Cerebral perfusion thresholds.
Deep vein thrombosis prophylaxis.
Hyperosmolar therapy.
Hyperventilation.
Indications for intracranial pressure monitoring.
Infection prophylaxis
Intracranial pressure thresholds.
Nutrition.
Prophylactic hypothermia.
Steroids.
