A Life-Saving Medical Program: How two MidAmerica Stroke Network Hospitals Collaborated to Treat a Life-Threatening Traumatic Brain Injury 
On Saturday, August 10, 2013, St. Louis resident, Sandy Kertz, 51, was visiting her hometown of Ste. Genevieve, Mo. to attend the town’s annual arts and crafts festival, Jour de Fete, with her daughters and some friends. After the festival ended, Sandy and her family visited a friend’s home. While relaxing in the basement, Sandy noticed that her cell phone was dying, so she started to walk upstairs to retrieve a phone charger.

When an Accidental Fall Becomes Life-Threatening

“I was wearing flip flops, and on my way up the steps, I fell backwards screaming, hitting my head on the floor,” recalled Sandy. “I immediately blacked out and my friends called 911. And when I awoke moments later, I couldn’t remember the name of my son.”

While en route to Ste. Genevieve County Memorial Hospital, Sandy began vomiting and became unresponsive. Her condition was rapidly deteriorating. She also had a blown pupil. Led by Michael Kolda, MD, the emergency medicine team at the hospital intubated Sandy and ordered a CT scan, which quickly confirmed the extent of Sandy’s traumatic brain injury (TBI) – it was an epidural hematoma (EDH).

An Epidural Hematoma

Often caused by a traumatic blow to the head, EDH is the buildup of blood between the skull and the thick, protective membrane that covers the brain. One of the most tell-tale signs of EDH is a brief loss of consciousness followed by an awareness period – the lucid interval – that can last several minutes or hours before brain activity completely deteriorates, often leading to a coma. Other symptoms may include headache, vomiting, drowsiness and seizures. Prompt medical treatment is crucial; otherwise, the patient may suffer irreparable brain damage or even death.

“Fortunately, the paramedics were incredibly astute, detecting a deterioration in Sandy’s mental status on the drive to the ER,” recalled Dr. Kolda. “Our ER staff, respiratory therapy and night supervisor operated efficiently and effectively to establish an airway and administer medications.”

Dr. Kolda knew Sandy’s condition required major brain surgery to repair the hematoma. Fortunately, he and the ER secretary knew they could rely on a critical care program for advanced neurosurgical support: the MidAmerica Stroke Network (MASN).

A Collaborative Partnership that Saves Lives

As a member of the MASN, Ste. Genevieve County Memorial Hospital can collaborate with Saint Louis University (SLU) Hospital’s neurospecialists 24 hours a day, seven days a week. Founded by SLU Hospital in 2008, the MASN promotes quality stroke care measures throughout the region by providing 56 member hospitals – 33 in Illinois and 23 in Missouri – with 24-hour access to neurospecialists, express transportation services for stroke patients, and state-of-the art technology for consultative and diagnostic services. The Network’s neurospecialists have also provided guidance and emergency medical care for patients with major head injuries, including TBIs.

The ER secretary called the MASN’s access line, allowing Dr. Kolda to consult with Ann Marie Flannery, MD, a SLUCare neurosurgeon and trauma specialist at SLU Hospital. Dr. Kolda sent Sandy’s CT scans to Dr. Flannery as they discussed Sandy’s diagnosis and what was necessary to prepare her for surgery. “Dr. Flannery recommended temporizing measures and accepted Sandy’s transfer without hesitation,” said Dr. Kolda.

“I advised Dr. Kolda to administer Mannitol through Sandy’s IV to help control any potential brain swelling,” recalled Dr. Flannery. “In the meantime, we prepped the OR and were on standby for Sandy’s arrival.”

Emergency, Life-Saving Brain Surgery

Less than an hour after she arrived at Ste. Genevieve County Memorial Hospital, Sandy was airlifted to SLU Hospital for brain surgery. As they waited for Sandy, Dr. Flannery and her team thoroughly reviewed her CT scans, saving them from having to do repeat studies upon Sandy’s arrival. She was able to go directly from the helicopter to the OR.

During the nearly three-hour procedure, Dr. Flannery and her team performed a right craniotomy and removed the epidural hematoma and blood clot, effectively stopping the bleeding in Sandy’s brain. Once she was stabilized, she was transferred to the intensive care unit.

“Sandy did very well with surgery, and the initial scans were promising,” said Dr. Flannery. “From the surgeon’s perspective, it was a textbook case. The only thing we can’t be sure of in a case like Sandy’s is how the patient will do during the recovery process. The brain must be given plenty of time to heal, so only time can tell.”

After the surgery, Dr. Flannery called Dr. Kolda to update him on Sandy’s condition and prognosis. It was a gesture that Dr. Kolda truly appreciated. He was concerned about Sandy and was thankful to hear about her outcome.

Two days later, Sandy was extubated. She would remain at SLU hospital for the next several days. Sandy didn’t recall any part of her surgery or inpatient stay at the hospital.  In fact, her only memory was having the 70 staples removed from her head shortly before being transferred to a rehabilitation facility for one week.

“Apparently, I was a fairly challenging patient,” chuckled Sandy. “I constantly tried to remove the tubes and IVs. In my mind, I couldn’t understand why or how I got there. It was all a blur.”

The Road to Recovery

Sandy experienced various side effects on the road to recovery, including severe headaches and regular hot flashes. She also had significant weakness in her left hand and fingers. She was ordered to undergo outpatient therapy – cognitive and occupational – twice a week for six to eight weeks to help strengthen her brain function and the left side of her body. Sandy also had to take a driving class before she could drive again.

“I’m a nurse and I didn’t have an awareness of how critical I was,” says Sandy. “I’m thankful that a hospital like Ste. Gen has the ability to transfer so easily. Thanks to Dr. Kolda and Dr. Flannery, I received the emergency care I needed. They preserved who I am and saved my life.”

Less than six months after the accident, Sandy has completely recovered. She still has slight numbness in her left toes and a little bit of weakness in two fingers. More importantly, she has no noticeable deficits with brain function. She even returned to her job as a nurse at Mercy Hospital in January 2014. Her family, including her husband and three kids, is also thrilled to have their Sandy back.

“Some days, I can’t believe I’m still alive,” said Sandy. “One of my doctors said my recovery is truly miraculous, and I completely agree.”

“Sandy’s TBI exemplifies how a system – the MASN – that’s designed to save lives should work. Her case was a truly time-dependent and life-threatening accident,” said Dr. Kolda. “Without the seamless performance of each component of the system and the luck we had with the weather conditions, Sandy’s positive outcome could’ve been much different. A clearly intelligent and talented wife, mother and professional, Sandy’s return to life and work was the best outcome we could’ve asked for.”

# # #