Adult Injuries

New Brain Injury Treatment at VGH Improving Outcomes

Thursday, December 15, 2016 By Admin

Autoregulation monitoring, a new procedure for treating patients who have suffered traumatic brain injury, is now being used at Vancouver General Hospital.

In a healthy brain, autoregulation is an intrinsic control mechanism that maintains constant cerebral blood flow and oxygenation. When a person suffers a traumatic brain injury, their autoregulation mechanisms are impaired, and the brain may not receive enough oxygen in order for it to properly heal and recover.

Blood pressure plays a key role in determining how much oxygen the brain is receiving. In autoregulation monitoring the medical team inserts a catheter into the patient’s brain. The catheter is then attached to a monitor. The patient’s blood pressure is manipulated with medications to make the heart pump harder, which causes the patient’s blood pressure to increase dramatically. As a result, the patient’s brain receives the correct amount of oxygen within hours.

Dr. Donald Griesdale and Dr. Mypinder Sekhon studied autoregulation monitoring at the University of Cambridge in the United Kingdom, and were instrumental in bringing the treatment to Vancouver.

Competitive freestyle skier, Jamie Crane-Mauzy, was the first patient in British Columbia to undergo this treatment. On April 11, 2015, she crashed while competing in the World Ski and Snowboard Festival in Whistler, suffering a severe traumatic brain injury that resulted in microbleeds throughout her brain and brain stem. Through autoregulation monitoring, Crane-Mauzy’s doctors learned that her oxygen levels were critically low. They were able to raise her blood pressure with medications to allow her oxygen levels to normalize within hours. Crane-Mauzy had to learn to walk and talk all over again, but she credits autoregulation monitoring with helping to save her life and get her back on her skis again.

Since then, 36 other patients have been treated with autoregulation monitoring at VGH. The doctors involved in the treatment report that 60% of patients have had favorable outcomes with autoregulation monitoring, compared to 37% of patients previously. According to Dr. Griesdale, “This technique is giving severe brain injury trauma patients a better shot at recovering to the point where they are able to live independently.”

Medico-legal review suggests that physicians miss the signs of stroke

Friday, June 24, 2016 By Admin

A recent review of cases conducted by the Canadian Medical Protective Association, an organization that defends physicians in Canada, has found that most medical malpractice cases involving stroke had issues with the diagnosis. This means that sometimes doctors are missing the signs of stroke at initial presentation thereby depriving patients of necessary prompt treatment. In the cases reviewed, more than 25% of patients died and another 40% were left with a significant disability.

In the reviewed cases, the common stroke symptoms were headache, dizziness, nausea and vomiting. Delayed presentation with longer symptom duration spanning days and sometimes weeks was also seen. We can take it from the CMPA synopsis that cases where there was atypical presentation of stroke were generally easier to defend, especially where there was adequate neurological assessment and where appropriate discharge instructions were provided to a patient.

Malpractice cases that were more successful included situations where physicians
Failed to recognize the seriousness of the patient’s condition with red flags such as a new or severe headache, or focal neurological signs,
Did not perform a full physical examination including full vital signs, orientation, gait, speech, finger-to-nose testing, and visual field assessment, examination of the cranial nerves and motor and sensory function in all four extremities,
Developed an inadequate differential diagnosis,
Failed to consider the possibility of stroke in patients who have obvious risk factors such as smoking, obesity and hypertension,
Anchored on a specific diagnosis such as migraine or psychiatric disorder without considering the possibility of stroke.

Research suggests that up to 10% of strokes are not recognized at initial presentation. Research also shows that earlier diagnosis and treatment of stroke can improve outcomes. If you or your loved one suffered an injury as a result of a stroke and you were seen at the hospital or at a medical clinic and you believe that the diagnosis was potentially missed or delayed, you may be entitled to compensation for the injuries. At Pacific Medical Law we often hear from patients who have experienced a misdiagnosis or delayed diagnosis of stroke that left them with a permanent disability. Although it is not possible to identify negligence in every case we review, we have been successful at helping clients obtain much-needed compensation for the injuries that they suffered as a result of a missed or delayed diagnosis of stroke.

You can read more about the CMPA case review findings here: https://www.cmpa-acpm.ca/-/stroke-can-you-recognize-the-signs-

Cauda Equina – when timing is everything in diagnosis and treatment of low back pain

Tuesday, May 24, 2016 By Admin

Low back pain affects millions of people and is quite common. Most often, it resolves on its own. In rare occasions, severe back pain can be a symptom of cauda equina syndrome, a serious neurologic condition in which damage to the cauda equina network of nerves causes loss of function of the spinal cord. Cauda equina syndrome can be caused by a variety of medical conditions including herniated disks, tumors, fractures or infections. The most common cause, however, is a prolapsed or herniated disk.

Symptoms of cauda equina include low back pain, bilateral leg pain, “saddle” anesthesia, weakness in the legs, loss of sensation around perineal and/or perianal areas, and bladder or bowel incontinence/retention. This syndrome is considered a true surgical emergency meaning any patient who exhibits the signs and symptoms of cauda equina should be taken to the OR as soon as possible for surgical decompression of the nerves involved. Cauda equina syndrome occurs relatively rarely, but a missed or delayed diagnosis of the condition often becomes the cause of action in medico-legal lawsuits.

Some of the more common examples of medical negligence involving the delayed diagnosis of cauda equina syndrome include the following medical mistakes:

failing to complete a thorough medical exam, including checking the rectal tone,
failing to diagnose saddle anesthesia by eliciting proper history from a patient,
failing to obtain emergency imaging,
failing to refer a patient for an urgent consultation with a qualified spine surgeon,
failing to recognize bladder/bowel incontinence as absolute emergency symptoms,
failing to provide a patient with appropriate instructions as to when to seek emergency help,
failing to organize and perform the surgery right away.

Prompt surgical decompression of cauda equina syndrome results in improved patient outcomes. Care providers must view cauda equina syndrome as an absolute emergency that requires prompt diagnosis, consultation and treatment.

Looking for Brain Injury Support in Your Community?

Thursday, March 17, 2016 By Admin

Many of our clients have suffered a permanent brain injury as a result of misdiagnosis or late diagnosis of a medical condition by their treating physicians or other health care provider, or as a result of complications during a surgical procedure.

Recovering from a brain injury and reestablishing a good quality of life is a challenging and often lifelong process. One of the critical aspects of success is finding support from the various organizations located in your community.

We often refer our clients to the brain injury associations and support groups in their local communities. Below, we have compiled a list of such organizations that may be able to assist you in your road to recovery.

Acquired Brain Injury Society of Yukon 867-667-4180

Alberni Valley Head Injury Society 250-724-6772

Barrier/Merritt Brain Support Outreach 250-372-1799

British Columbia Brain Injury Association 604-984-1212 brainstreams.ca

BrainTrust Canada 250-762-3233 (Kelowna) 250-307-6064 (Vernon) braintrustcanada.com

Bulkley Valley Brain Injury Association 250-877-7723

Burnaby Chinese Brain Injury Support Group 604-877-8606

Campbell River Head Injury Support Society 250-287-4323 crhead.ca

Comox Valley Head Injury Society 250-334-9225 cvhis.org

East Kootenay Brain Injury Association 250-417-6220

Fraser Valley Brain Injury Association 604-557-1913 1-866-557-1913 fvbia.org

Golden Brain Injury Support Group 250-344-5688

Kamloops Brain Injury Association 250-372-1799 kbia.ca

Maple Ridge Support Group Nora Chambers: 604-462-9392 [email protected]

Nanaimo Brain Injury Society 250-753-5600 nbis.ca

New Westminster Headway 604-520-0130 howesound.net/headway

North Okanagan Shuswap Brain Injury Society 250-833-1140 nobis.ca

Northern Brain Injury Association 250-562-4673 1-866-979-4673 nbia.ca

Powell River Brain Injury Society 604-485-6065 braininjurysociety.ca

Prince George Brain Injured Group Society 250-564-2447 1-866-564-2447 pgbig.ca

Sunshine Coast Brain Injury Support Group Susan Goddard: 604-885-8524

South Okanagan Brain Injury Society 250-490-0613 sosbis.com

TriCities Support Group Sandy Caverly: 604-937-3525

Vancouver Headway 604-732-4446 howesound.net/headway

Victoria Brain Injury Society 250-598-9339 vbis.ca

West Kootenay Brain Injury Association 778-460-4500(Castlegar) wkbianews.com 778-517-5533(Cranbrook)

Reports to Nova Scotia Medical Error Registry Increase in 2015

Wednesday, March 9, 2016 By Admin

In the second year of its operation, the Nova Scotia Medical Error Registry had recorded an increase in reported errors from 77 in 2014, to 128 in 2015, according to numbers released in the province’s Serious Reportable Events database. That increase may not reflect an increase in errors, but rather a shift in practice, as the reporting of errors becomes part of the culture of improving health care.

Nova Scotia has been tracking medical errors in their hospitals since January 2014. The medical errors that must be reported are serious reportable events, which are defined as an adverse health event which results in serious disability or death and includes but is not limited to the actual or potential loss of life, limb or function related to a health care service.

In 26 of the 205 events reported since the inception of the program, patients suffered death or disability due to a misdiagnosis or an unspecified care management problem.

At Pacific Medical Law we often hear from people who have experienced a delay in the diagnosis of a serious medical condition that leads to life-long disability. For example, the misdiagnosis or delayed diagnosis of a spinal epidural abscess causing a spinal cord injury can result in a life spent in a wheelchair. Although it is not always possible to identify negligence in each of these cases, we have been able to help many clients obtain compensation for these injuries.

Read the full Nova Scotia Medical Error Registry story here:

http://www.cbc.ca/news/canada/nova-scotia/nova-scotia-medical-event-database-1.3461082

See the Nova Scotia data from 2014 to 2015 here:

http://novascotia.ca/dhw/hsq/serious-reportable-events.asp

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