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Recent posts
- Anger vs Depression January 2, 2021
- PTSD and Comorbidity January 2, 2021
- Do they know how they feel, and why? January 2, 2021
- Violence Against Nurses November 15, 2020
- Anxiety’s Impact upon Informed Consent October 29, 2020
- The Phenomenon of Memory January 13, 2018
- Projecting Costs: the Larger Picture December 23, 2016
- The Changing Face of Body Language December 23, 2016
- You thought this case had merit June 8, 2016
- Authenticity March 23, 2016
- The Dependency Curve – Guest Post from Dr. David B. Adams October 4, 2015
- Mediating with a Full Deck September 3, 2015
- Maintaining the Veil of Anonymity June 23, 2015
- Stroke and CHI – Key Concepts for Legal Professionals February 22, 2015
- Stroke and CHI – Key Concepts for Legal Professionals February 7, 2015
- Questions from Jurors are GOOD, Period. August 1, 2014
- PTSD – Part One: Causation and Symptoms July 23, 2014
- With the Right Chronology, You too May Enjoy a Deposition May 13, 2014
- The Autopsy – a Dying Recommendation April 22, 2014
- LNCC and CLNC – what do these initials mean, really? January 19, 2014
- Writing Your First Report January 11, 2014
- What Your Attorney Needs from You January 10, 2014
- The Mental Health Divide, Part II November 11, 2013
- Your Attorney Knows this – Do You? October 13, 2013
- The Mental Health Divide, Part One July 28, 2013
- How Much Time Does it Take to Create a Chronology? June 27, 2013
- Still looking at those records? June 15, 2013
- Can Anyone Create a Chronology? June 2, 2013
- The Changing Face of Body Language May 14, 2013
- Do I Have Your Attention? April 25, 2013
- The Words We Choose March 23, 2013
- Grammar & Composition 101 March 13, 2013
- Deadlines & Commitments: What to Leave In, What to Leave Out (Bob Segar) February 28, 2013
- I’ll take jurors for 100, Alex February 14, 2013
- Sleep is good. Work is good. Working without sleep…not so good February 5, 2013
- BYOB – Part III of III – Making it all Work January 20, 2013
- BYOB Part II of III: Putting your nose to the grindstone January 5, 2013
- BYOB: Building Your Own Business: Part I of III December 18, 2012
- When the shoe is on the other appendage November 28, 2012
- Thoughts for the New Nurse November 22, 2012
Monthly Archives: February 2015
Stroke and CHI – Key Concepts for Legal Professionals
Head injuries or brain damage can occur anywhere – in the workplace, in an MVA, in medical malpractice, toxic torts, a domestic fall, and environmental exposures.
Litigated head injuries generally arise from two sources:
1. Accidents
a. blunt trauma (fall, violent blow or MVA)
b. penetrating trauma (gunshot)
2. Medical causation (stroke)
a. ischemic (a clot blocking blood flow to a major artery)
b. hemorrhagic (rupture of a major artery causes damage to the brain)
c. TIA or Transient Ischemic Attack (symptoms resolve within 24 hrs)
In all instances, brain injury is affected by blood: either blocked flow (ischemia) or bleeding that puts pressure on another area, damaging tissue. The location of the injury is the most important determinant of the severity and likelihood of recovery.
Key Concepts
• Rate and degree of recovery after brain injury is quite variable
• The most common form of traumatic brain injury is the subdural hematoma (SDH), with a mortality rate ranging from 50 – 90%. A significant percentage of these deaths result from the pressure on the brain that develops in the days after injury. Treatment of the SDH depends upon the location and age of the lesion. Because bleeding is not static, “Early and sometimes repeated CT scanning may be required in cases of clinical or neurologic deterioration, especially in the first 72 hours after head injury, to detect delayed hematoma, hypoxic-ischemic lesions, or cerebral edema.”
• Approximately 20-30% of patients will recover full or partial brain function. However, post-operative seizures are relatively common in these patients.
• Although recovery from TIA (transient ischemic attack) occurs within 24 hours, these patients may be at a high risk for falls if they may regain mobility before being aware of their surroundings.
• Strokes arising from blood clots usually require anticoagulation therapy to prevent further clotting, but improper medication management can result in a fatal hemorrhage
• Because patients can “go bad” quickly, frequent monitoring of vital signs, ICP (intracranial pressure) measurements, lab values, pupil checks and level of awareness is crucial.
• A critical part of assessment includes changes, even by one point, in the Glasgow Coma Scale
The Glasgow Coma Scale (GCS) numerically represents the level of consciousness and is based upon a 15-point scale for estimating and categorizing the outcomes of brain injury. The patient who is unable to respond verbally or follow commands can nonetheless have a reflexive response to painful stimuli. Families do not appreciate this form of assessment, but the patient’s physical response tells a great deal about how the brain is processing this noxious stimulus. The following signs are associated with a poor prognosis:
• A Glasgow Coma Scale less than 8 in the field
• A Glasgow Coma Scale less than 5 in the ER
• Unequal/changing pupil size
• Motorcycle accident (direct head impact and no airbag)
• Problems with ventilation, further depriving the brain of oxygen
A patient with an acute and severe brain injury may be placed into a medically induced coma to protect and allow the brain to rest by slowing metabolism. Mechanical ventilation controls oxygen and carbon dioxide levels that can aid in reduction of swelling, and sedation allows an override of the patient’s breathing, which is often labored and dysfunctional.
Pain should be managed effectively because it can lead to a rise in intracranial pressure. An intubated patient is treated with short acting sedation and analgesia until time for weaning.
Claims for pain and suffering in the unconscious patient should consider:
• The victim’s awareness of impending danger prior to the head injury (an assertion of this awareness has been successfully argued even with death cases)
• Successfully communicating to a jury the difference between purposeful movements and reflex, and
• Evaluation of post-injury residuals established by Medical Cost Projection or Life Care Plan.
Putting post-injury impairment into perspective, it is very important to know the level of prior intellectual and emotional functioning. This information is sought by defense counsel in quantifying financial responsibility, and is equally important to plaintiff’s counsel in supporting a reasonable demand.
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Alice Adams is a veteran RN who has cared for many acute head injury patients. She has been a legal nurse consultant since 2006 and lives in Atlanta, GA. She evaluated the injury cases in the 2007 Bluffton University Baseball team’s tragic accident and fatalities, and is very active compiling Medical Cost Projections and providing medical analysis for >40 attorneys and law firm.
http://www.aliceMadams.com nurseatlanta@gmail.com 404.771.5155
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