Non-direct Trauma - vertebral artery dissection

[firedoc5]

I had a guy one night with similar injury. But his vertebral artery dissection was due to being punched in the face. Of course it had to be in the middle of a bar parking lot in a torrential downpour.

KEYSTONE, Colo. -- A 28-year-old snowboarder who fell "quite hard on her buttocks" during a beginner's run at Keystone Ski Resort died from irreversible brain damage, the Summit County Coroner concluded.

Jennifer Ash, of Indianapolis, was snowboarding on the Ina's Way run when she fell March 16. The Ski Patrol was not notified because her fall was not deemed serious.

However, when she continued to experience pain, her friends drove her to Summit Medical Center where she was evaluated. She was airlifted to St. Anthony's Central Hospital in Denver where it was discovered that she had suffered "vertebral artery dissection" or a tear in a vertebral artery, which resulted in a "basilar artery stroke and brain damage," Coroner Joanne L. Richardson said in a report.

Ash had irreversible brain damage from the stroke and was pronounced brain-dead four days later, on March 23. The manner of her death has been ruled accidental.

"This type of injury occurs with an indirect trauma -- where there is a whipping motion of the neck that can be a hyperextension or from side to side. The decedent was not wearing a helmet, although it would not have assisted in this case," Richardson said in her report.

"We are sorry to hear about her death. The resort extends our deepest sympathies to her friends and family," said Keystone spokeswoman Kate Lessman.

She said the resort wasn't told of the injury on the mountain and didn't know about Ash's injury until Friday, when the coroner released her report.

"Usually, when there's an incident on the mountain, the people in the party will call the ski patrol. The ski patrol was not contacted in this case," Lessman said.

Ash had arrived in Colorado the day before with friends for vacation. She was a pharmacy professor at Butler University in Indianapolis.

She received her doctorate in pharmacy from Butler in 2003, and was in her first academic year on faculty at Butler's College of Pharmacy and Health Sciences, according to Butler spokeswoman Courtney Tuell.

[mobey]

Every day I get more and more pissed off with how much I don't know in the medical field.

Saturday night palsy

Suspention trauma

Now this :roll:

Thanks for the post firedoc

[Scaramedic]

It never ceases to amaze me how a little incident can lead to amazing injuries. I once a had a women who had a tire blowout on the highway she skidded to a stop and did not hit anything. Yet she was c/o neck pain, turns our she a has a C6 fracture. Young lady, no history of osteoporosis or history of anything for that matter. Yet I've seen vehicles go airborne, roll over five times and the occupant walks away without a scratch. It never makes sense to me.

Like Stephen King once said in a book, "when God tells you to hang up your jock it does not matter what your age or health, it's over and there's not a damn thing you can do about it."

[Just Plain Ruff]

one time worked a trauma code on a working girl.

turns out her pimp was pissed at her and stabbed her in the leg. When we got there she had a 1/2 inch lac to her innter thigh.

We moved her to the cot and 10 minutes later she arrested.

Turns out the knife the pimp used was a 1/2 wide 12 inch long scimitar like knife. It lacerated her femeral artery and she bled out into her thigh. She was 89 pounds if she was anything.

Her pimp came in the ER and asked to see her and was arrested for homicide. When asked if he stabbed her he said "hell yes I stabbed her, she owes me 200 bucks for last night"

[kristo]

Every day I get more and more pissed off with how much I don't know in the medical field.

Saturday night palsy

Suspention trauma

Now this :roll:

Thanks for the post firedoc

A short explanation:

The vertebral artery is a branch of the subclavian, which ascends through the transverse foramina from C6 (if I remember correctly) to C2. It then goes posteriorly, then pierces the posterior atlantooccipital membrane and enters the skull through the foramen magnum. This placement obviously makes it pretty vulnerable in neck injuries.

Now, inside the skull, the vertebral arteries on each side join to form the basilar artery. The basilar artery then branches into the bilateral posterior cerebral arteries (PICA). Those arteries, ie. the vertebral, basilar, and PICA, provide blood supply for the brainstem (medulla oblongata, pons, and mesencephalon (midbrain)) and the cerebellum.

Now, we actually can live without the cerebellum (although we would not have well coordinated motor function), but in the brainstem are the nuclei of the cranial nerves, which appear as columns that run caudorostrally through the brainstem.

In this case, the tear in the vertebral artery will have caused ischaemia in the medulla oblongata, where, among others, the dorsal motor nucleus of the vagus nerve resides. That nucleus handles regulation of respiratory and cardiac function. The basilar artery gives pontine brances, which supply the pons, where more cranial nerve nuclei reside. In short, this is bad, mmkay...

To the best of my knowledge, the circle of Willis, which is a large anastomosis of arteries from the internal carotid and basilar arteries, can compensate for some lack of perfusion from either end, but definately not a lot.

[CBEMT]

firedoc, would you mind posting or sending me a link to that story? I'd love to send it to my younger EMTs as a case study.