Degloving crush injury to arm from roll-over

Illustrated Medicine: Case Study

Degloving crush injury to arm from roll-over

Incident
Mr. Black was a belted backseat passenger involved in a head-on collision with roll-over. He was thrown from the vehicle and suffered significant injuries to his upper limbs.

Purpose of illustration
This exhibit was required to demonstrate his severe right upper limb crush injury with degloving, as well as his associated fractures and 3rd degree burns. The soft-tissue and bony injuries were illustrated separately to fully communicate the extent of the trauma.

Rationale for litigation visual
Voluminous hospital reports and imaging studies noted the profound nature of Mr. Bourne’s upper limb trauma – this visual served as a summary panel for the right arm pathology.

Complications
Mr. Black required numerous upper limb surgeries, including reduction of his fractures, transplantation of skin from his thigh to cover the forearm and hand degloving, and release of elbow ankylosis that resulted from the trauma.

Other visuals demonstrated
Additional panels detailed the other surgeries performed, as well as the severe trauma to his left hand, including fractures, partial amputation of several fingers and the associated surgeries.

Outcome
The case settled at the conclusion of a two-day mediation.

The illustrations Artery Studios creates … are always of the highest quality. They are simply indispensable as demonstrative aids in graphically illustrating both the trauma mechanism and permanency of the injuries sustained by our clients...  I highly recommend Artery Studios’ involvement in any serious personal injury case.” – Michael Lamont, Lamont Law


Double puncture of colon during gallbladder surgery – Case settles prior to trial

Illustrated Medicine: Case Study

Double puncture of colon during gallbladder surgery –
Case settles prior to trial

Incident
While undergoing cholecystectomy surgery, the anterior and posterior walls of Mr. Rossi’s transverse colon were perforated, leading to fecal peritonitis, adhesion formation and incarcerated (trapped) umbilical hernia.

Purpose of illustration
This exhibit was created to demonstrate the mechanism of injury to Mr. Rossi’s colon – as per the findings upon surgical reopening, associated imaging and the case medical reports.

Rationale for litigation visual
This illustration clarifies the complex medical terminology and difficult-to-understand radiology. It provides a clear view of what occurred during the initial surgery.

Complications
Brown fluid was observed in Mr. Rossi’s abdominal drains, and intra-abdominal air was seen on CT – indicative of a perforated bowel. He required surgical repair of the perforations, removal of pus and omentum from his abdominal hernia, and a colostomy. Later, surgical reversal of his colostomy site was undertaken along with repair of the abdominal hernia. He developed a pulmonary embolism after this surgery, resulting in his death.

Other visuals demonstrated
Additional exhibits demonstrated: the anatomy of the abdomen and intestinal tract; enlargement of Mr. Rossi’s hernia (as per CT imaging); as well the numerous surgeries performed.

Outcome
The illustrations were used at a settlement conference and the case resolved close to the doctor’s policy limits.

"Working with Artery Studios was instructive because of their knowledge of anatomy and how to illustrate it … and skills and capacity to demonstrate tissues, planes, and perspective. The images helped my understanding and to feel more confident in what we could present to a jury … and that positively impacted our settlement negotiations."  – James Coogan, Dwyer & Coogan, PC


T-bone impact causes knee fracture – Case settles close to $1,750,000.00

Illustrated Medicine: Case Study

T-bone impact causes knee fracture – Case settles close to $1,750,000.00

Incident
When Ms. Smith was T-boned by the defendant running a red light, her right knee violently impacted the console, causing a depressed lateral tibial plateau fracture.

Purpose of illustration
This trauma panel was created to demonstrate the details of her significant intra-articular fracture.

Rationale for litigation visual
This exhibit visually ‘translated’ the confusing CT scans and medical reports into a crystal-clear illustration of her injury pathology, allowing all litigation participants to fully understand the extent of the damage.

Complications
Ms. Smith required reconstructive surgery, including elevation and reduction of the displaced bone fragments and bone grafting. Her knee was predicted to deteriorate with post-traumatic osteoarthritis and require pain management.

Other visuals demonstrated
Additional exhibits showed the surgery and complication issues, as well depictions of her concomitant brain injury which resulted in post-concussion symptoms and visual challenges.

Outcome
The case settled before trial, close to $1,750,000.00.

"The medical illustrations Artery Studios creates are always very helpful in formal settlement meetings, be it a mediation or a pretrial conference.The illustrations explain the injury to defense, and show details of any surgery and the long term consequences of the injury. Defense counsel and the adjuster realize how impactful the illustrations will be if the case proceeds to trial and the effect they can have on damages awards. Artery’s illustrations help impress my opponent with the seriousness of the case and assist me with resolution of it."  – John McLeish, McLeish Orlando


Ruptured appendix leads to permanent brain injury - $3.2M jury award

Illustrated Medicine: Case Study

Delayed appendicitis treatment causes hypoxic brain injury – $3.2M jury award

Incident
This 11-year-old boy with Down Syndrome suffered a ruptured appendix from delayed diagnosis and surgery, leading to unrecognized septic shock that triggered cardiopulmonary arrest, resulting in hypoxic brain injury.

Purpose of illustration
This illustration panel was created for use as an introductory exhibit, to demonstrate normal anatomy of the appendix and the pathology of early appendicitis versus Jason’s subsequent ruptured appendix with extensive ascites in his abdomen – as seen on CT.

Rationale for litigation visual
The exhibit allowed the jury to clearly understand the difference between early diagnosis of appendicitis and treating it initially, versus the significant abdominal pathology that resulted from rupture of the appendix due to delayed treatment.

Complications
Initially treated with antibiotics and a drain, he later underwent an appendectomy (which revealed interim abscess formation). The delay in surgery triggered cardiopulmonary arrest due to septic complications affecting his pacemaker wires, with a lengthy period of anoxia resulting in permanent brain injury.

Other visuals demonstrated
Additional exhibits included a series of comprehensive interactive timelines, as well as illustrations of the client’s anoxic brain injury issues.

Outcome
Prior to trial there was no settlement offer made by the defendants. The jury reached a $3.2 million verdict.

“Throughout the trial, the use of demonstrative exhibits prepared by Artery Studios was invaluable in educating the jury about the many complicated medical issues as well as the long timeline involved in this case. The exhibits and timelines prepared by Artery Studios aided us in telling our client’s story to the jury, and we believe these exhibits were instrumental in the positive result for our client.” 

– Gena Romagnoli, Henry Phillip Gruss Ltd


Remote Control - Part 2

REMOTE CONTROL – Part 2

More tips for maximizing success in online mediations

In Part 1 we discussed office configuration, lighting, internet speed, and using PowerPoint to integrate photos into your video-conferenced mediations. Let’s explore how visual communications can further enhance your negotiations.

Capitalize on show-and-tell
Don’t make the mistake of being a talking head, orating about your client’s issues while eyelids grow heavy. As your comfort level with the online experience increases, up the impact of your presentations by inserting medical illustrations, animation clips, video footage, timelines, etc. As we all know, a digital interface isn’t as up-close-and-personal as meeting face-to-face, so using visuals to engage others, while explaining the complex medical facts of a file, creates a richer connection. Medical illustrations will catch and hold attention and put you firmly in the position of being the source for relevant and reliable information.

Keep all eyes on the ball – your client
One potential pitfall of video conferencing is that your client can appear postage stamp sized on screen – a problem when you want the session to be all about them. To ensure everyone keeps focused on the heart of the matter, include a photo of your client, and their name, on each of your slides. This provides a constant visual reminder of “Mr. Smith” and his trauma issues.

Tell me a story
Visual storytelling allows for not only an enhanced emotional appeal, but also provides a path for others to follow along. Visuals should be kept simple, with each slide showing one clear concept. Make the slides build on each other, telling the story one ‘paragraph’ at a time. Educational researchers refer to this as scaffolding (Pea, 2004). A presentation that builds will show the full arc of your client’s story, demonstrating evolving trauma issues, surgical procedures, or deterioration issues, in a step-by-step manner that will vividly communicate what they had to endure.

Knock it out of the park
Wrap up your client’s story with an overview chart or full-figure illustration that drives home their injury complications. Summary visuals combined with before and after photos will leave a lasting impression that’ll maximize outcomes and help resolve the file successfully.

We hope these tips will invigorate your mediations to help you get the most from your online negotiations.

Reference: Pea, R., & Mills. (2004). The Social and Technological Dimensions of Scaffolding and Related TheoreticalConcepts for Learning, Education, and Human Activity. The Journal of the Learning Sciences, 13(3).


Remote Control - Part 1

REMOTE CONTROL – Part 1

Tips for maximizing success in online mediations

So, you’re working remotely and conducting mediations for PI files. How do you make an impact when everyone’s not in the same room? Here are some reminders for making your Zoom zing!

1 – The Camera Never Lies
We all do it – forget about the too-bright window behind you or vase of wilted flowers. First thing is to make your background look great. Rearrange your home office to show off your diplomas, a bookcase of legal tomes, maybe an anatomical model – whatever it takes to telegraph that you’re a serious and professionally-grounded PI litigator. Oh, and remember that your camera may be hi-res – so lipstick on your teeth or stubble on your chin may be clearly in focus to others!

2 – Say What? 
Despite so much current online interfacing, garbled voices continue to be a recurring frustration for all. University students note that audio is the most important factor in effective online learning1. Since remote engagements are here for a while, it’s likely time to invest in a USB-plugin microphone that’ll make others hang on your every word – often for less than a hundred dollars. A headset with mic is okay, but you risk looking like a radio-host!

3 – At the Speed of Light 
If you’re working from home or the cabin, now’s the time to upgrade your internet, so your engagement is crisp, without lags or the dreaded frozen screen. This may entail a new router, hooking up WiFi repeaters, or running a direct-wire internet cable to a newly-created workspace. But the investment is priceless for making your mediations unfold as smooth as silk.

4 – Lights – camera – action 
Professional video bloggers (vloggers) use lighting tricks – and so should you. There are many light fixtures available that’ll cast you in a warm glow and make you clearly visible. A simple solution is a desk lamp with a 40W incandescent bulb (or LED in the 2,700-3,000 Kelvin range) shining towards you from the far side of your screen. Good lighting will make you look fresh, confident and in control.

5 – A picture of health (NOT…)
Video-conference platforms (like Zoom), cry out for visual storytelling. When you have the floor (screen), take control of the session in “presenter” mode, and hold attention by using visuals. They’ll keep your presentation on track and keep everyone focused on the key issues. Use before/after photos of your client, highlighted report excerpts, or shots of the vehicle damage. Once you get comfortable sharing your screen in mediation settings, take it up a notch with more advanced visuals that maximize outcomes – we’ll cover that in Part 2, so stay online…

(1) Findings from informal survey of University of Toronto graduate students in Biomedical Communications.


Rollover Causes Chest Trauma with Cardiac Arrest

Illustrated Medicine: Case Study

Rollover Causes Chest Trauma with Cardiac Arrest

Incident 
This 28-year-old passenger suffered multiple injuries from a rear-end collision that caused the vehicle she was into rollover and hit a pole. 

Purpose of illustration 
This exhibit was created to demonstrate Ms. Jones’s later internal chest trauma – namely, complete collapse of the middle and lower lobes of her lung, with blood filling 70% of the right chest cavity (hemithorax) and pushing against her heart. 

Rationale for litigation visual 
Although CT scans demonstrated the chest pathology to medical professionals, non-medically-trained litigation participants needed a visual ‘translation’ of the films and case reports, thereby allowing everyone to appreciate the severity of this trauma. 

Complications 
Ms. Jones underwent a thoracotomy to remove the large volume of blood from her chest. She then suffered cardiac arrest and an emergency sternotomy was performed to evacuate blood from the pleural space and to insert chest tubes. Bleeding from the innominate artery was discovered and ligated after sharp pieces of fractured clavicle and rib were removed. 

Other visuals demonstrated 
Additional illustrations depicted: multiple rib fractures causing ‘flail chest’; spinal, right clavicular and scapular fractures; and details of three chest surgeries that were performed. Complications of scapular winging and reduced shoulder mobility due to right thoracic nerve injury, as well as thoracic outlet syndrome, were also demonstrated. 

Outcome 
A significant settlement was reached just days before the trial was to commence.


Spinal Fusion from Dump Truck Rear-Ender

Illustrated Medicine: Case Study

Spinal Fusion from Dump Truck Rear-Ender

Incident 
This 50-year-old driver sustained significant injury when his vehicle was rear-ended by a dump truck, causing trauma to his cervical spine. 

Purpose of illustration 
This exhibit was created to demonstrate the appearance of his spine after it was surgically fused, providing a clear translation of the imaging and medical reports, including showing the bone grafts that were inserted to replace the bulging discs that were removed – details that were difficult to appreciate on x-rays. 

Rationale for litigation visual 
For those untrained in medicine, this illustration provides clarity for the complex surgery performed and hard-to-understand radiologically. It provides a concise view of what took place in the OR – showing the anterior plate affixed with screws to the vertebrae, the associated bone grafts and the incision. 

Other visuals demonstrated 
Additional panels illustrated the post-MVA pathology of Mr. Doe’s cervical disc bulges impinging his spinal canal, and the surgery that was required to reposition his symptomatic left ulnar nerve. 

Outcome 
Adam Starr of Jarve Kaplan Granato Starr LLC, used the exhibits at mediation to clearly communicate the key details of his client’s spinal pathology and required surgeries performed, securing a high six-figure settlement for his client.


Trucking Accident Triggers Stroke

Illustrated Medicine: Case Study

Trucking Accident Triggers Stroke

Incident 
This 53-year-old driver was hit by a truck twice – his car first spun and was then pinned against the concrete median – subjecting him to rotational, acceleration and deceleration forces. 

Purpose of illustration 
Designed to show how injury to his vertebral artery caused stroke damage to areas of his brain, this panel included details of: anatomy (arterial and cranial); physiology (bloodflow and thrombus formation); and pathology (ischemic damage). 

Rationale for litigation visual 
This illustration exhibit was required to allow litigation participants to connect the initial physical injury to the artery in Mr. Doe’s neck, with the resultant ischemic (stroke) damage in his brain – complex factors for most non-medically trained people to understand. 

Complications 
Due to instability in his upper cervical spine, he was prone to recurring transient ischemia, reducing the blood supply to his brain, causing him neurological problems. 

Other visuals demonstrated 
Additional illustrations showed other trauma issues of: exacerbation of pre-exisiting findings; double-crush syndrome in his upper limbs; cervical radiculopathy; rotator cuff syndrome; chronic pain, including neck, back, shoulder and leg pain; and possible future spinal surgery. 

Outcome 
The case settled very successfully as trial was about to begin. 

 


Shoulder Injury from Head-on Collision

Illustrated Medicine: Case Study

Shoulder Injury From Head-on Collision

Incident
This left-handed 56-year-old driver was involved in a head-on collision, causing soft tissue damage to her left shoulder as well as other injuries.

Purpose of illustration
This panel was created to show the mechanism of injury to her AC joint and supraspinatus tendon, resulting from a significant seatbelt force being suddenly applied to her shoulder during impact.

Rationale for litigation visual
The transmission of forces from the shoulder belt, to the clavicle and thereby to the bones and tissues of the shoulder, were key concepts to be communicated at trial. The illustration served to ‘translate’ the opinion of the biomedical engineer into a visual format, allowing for clear understanding.

Complications
Ms. May went on to experience persistent pain in her shoulder, reflecting the effects of inflammation and scarring of tendons, ligaments and bursa, with secondary mechanical effects.

Other visuals demonstrated
Additional illustrations showed more detailed findings of the shoulder pathology, as well as left knee injury concepts.

Outcome
Plaintiff’s lawyer, Norma Mayer, opined that “…the illustration was instrumental in resolving the file at mediation.”