Anoxic Brain Injury- Difficult Decisions Ahead
05/15/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD, Joe Motta, JD // (press release)
Following is the Medical, Life Care Planning, and Lawyer Perspective of Life Care Solutions Group’s Greg Vigna, MD, JD and Joe Motta, JD in regards to an Anoxic Brain Injury.
Anoxic brain damage is the result of an acute deprivation of oxygen to the brain and its severity depends on the length and severity of oxygen deprivation. This may result from significant trauma, profound shock from bleeding, drowning, and acute cardiopulmonary arrest followed by revival efforts of first responders. A coma is a state of unresponsiveness with the eyes closed. Sixty percent of patients with anoxic brain damage who are in coma after six hours following an ischemic event (inadequate blood flow) will either die or remain in coma at one month. The medical field has determined prognostic indicators within the first 72 hours that allows families to make a more informed decision regarding continued medical support following an anoxic event.
An extensive review of numerous studies have come up with recommendations related to determining outcomes in patients in coma as a result of an ischemic event. First, decisions related to treatment should be postponed for at least 24 hours after the ischemic event. Second, after 24 hours bilateral absence of median nerve somatosensory evoked potentials (SSEP) of the N20 reading suggests treatment will likely be with dismal results. Somatosensory evoked potentials are noninvasive means of determining the functional status of peripheral nervous system, spinal cord function, brain stem function, and cortical function. Third, if SSEP after 72 hours is present other findings such as absence of pupillary or corneal reflexes, extensor responses on motor exam, and an EEG with absent or burst suppression pattern indicate a likely poor prognosis.
Life Care Planner Perspective:
A life care plan is a road map of all necessary care required to maximize function, improve an individual’s quality of life, and decrease the incidence of complications to the life expectance of the patient. All recommendations must be medically necessary and appropriate to attain these goals. During the first week following an anoxic brain injury it would be unusual for a life care planner to be involved. This is unfortunate considering life care planners are health care providers who are best aware of resources in the community as well as in the country that can best serve the individual needs of an anoxic patient. Early, aggressive rehabilitation at a center of excellence can both improve outcomes as well as decrease complications in this fragile patient. A life care planner will look at available indicators of prognosis; interact with the doctors involved with the patient’s care to gain insight regarding current care needs and future needs of the patient and family going forward.
At this early stage, family support will take precedent over lawsuit related issues. It is very important that the rights of both the patient and the family of the injured are secured and protected. It is necessary for a patient and their family to do the following to preserve their rights going forward: 1) Avoid any potentially damaging admissions, 2) Preserve evidence (such as crash scene evidence) for further evaluation, 3) Verify the accuracy of police reports, and 4) Obtain contact information from witnesses, and 4) Discuss your situation with an attorney who is capable of dealing with the complexity of the medical diagnosis and can provide competent representation in the matter. The tragedies that befall a severe brain injury victim are unimaginable; they will have a catastrophic emotional and financial impact on every family’s future. More tragic are the cases where liability insurance of the other party (defendant) is inadequate to meet the lifetime needs of the anoxic brain injured patient. It is vital that the attorney investigate the cause of the accident and investigate whether there is a ‘deep pocket’ that can contribute to the financial responsibilities the flow from someone’s negligence/carelessness. Cause and responsibility may also be related to the manufacturer of a defective product. It is also imperative that the attorney has the skills and the resources to recognize whether the medical care surrounding anoxic client after the event was appropriate, and if not, to investigate whether there were any breaches in the standard of care, which aggravated or increased the severity of injury after the anoxic event.
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