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Oxytocin & Birth Injuries

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Strategies: Overcoming Defense

Overcoming these defense strategies will increase the value of your case.

Monday, February 29, 2016

Rollover Accidents – Dallas Auto Accident Lawyers

Rollover car accidents are responsible for 35% of passenger fatalities

Rollover accidents cause more than 10,000 deaths in the United States every year, according to the National Highway Traffic Safety Administration (NHTSA). Even though rollover accidents represent only around two percent of the total number of crashes in the U.S., they account for around 35 percent of passenger vehicle deaths.

Types of Rollover Accidents
A rollover accident occurs when a vehicle turns upside down or topples onto its side due to sudden braking, turning, or a collision with another vehicle. It takes some time to bring a speeding car to a stop. If you do not allow a speeding vehicle enough time and use harsh braking or take a quick turn at a high speed, it could result in rollover of the car. If you apply a sudden brake, the tires of the car stop moving forward immediately, but the vehicle’s momentum tips the vehicle over. Whether the vehicle will tip onto its side or turn upside down depends on a number of factors, including its amount of inertia and the direction of the car.

Rollover accidents can be of two types. One type, called a tripped rollover, is more common than the other type called an un-tripped rollover.

Tripped Rollover
A tripped rollover occurs when a speeding vehicle comes off the roadway to the side of the road. As the tires of the vehicle come in contact with soft soil or get obstructed by a pothole or solid object on the road, the force of the tires causes the vehicle to tip over.

Untripped Rollover
An untripped rollover occurs when the tipping over is not caused by any obstruction from an object of the road.

Common Causes of Rollover Crashes
Knowing the cause of a rollover accident would help you determine who was at fault for the accident and who is liable to pay compensation any losses suffered. If you are aware of the common causes of rollover accidents, you’ll be able to take precautions to prevent this type of accident.

A speeding vehicle is more likely to be involved in rollover accidents. Do not exceed the posted speed limit while driving.
Drunk driving or drowsy driving
Drivers who are tired or driving under the influence of alcohol are susceptible to make sudden decisions behind the wheel, causing accidents. Over-correction by intoxicated or tired drivers is a leading cause of rollover accidents.
Tire problems
Driving a vehicle with bald or flat tires is dangerous and often results in rollover accidents.

Common Injuries Caused by Rollover Accidents
Common injuries from rollover accidents include spinal cord injuries, broken bones, traumatic brain injuries, and internal injuries. Wearing a seatbelt could prevent 75 percent of rollover fatalities, according to the National Highway Traffic Safety Administration (NHTSA).

Contact Us
If you were severely injured or a loved one died in a vehicle rollover accident, we invite you to contact our Dallas offices at 214.987.0005 to discuss your rights and legal options with an experienced trial lawyer.

We offer free initial consultations to potential clients nationwide. If you are calling from outside the DFW Metroplex, please use our toll-free line at 888.987.0005 or contact us by e-mail to schedule an appointment.

Thursday, February 25, 2016

Common Types of 18-Wheeler Accidents

The weight and size of commercial trucks pose safety hazards for other vehicles sharing the road with them.

A truck can weigh anywhere close to 80,000 pounds and are not easily maneuverable as compared to passenger vehicles. A collision between a truck and a small car can have a disastrous outcome. Statistics reveal that a driver of a passenger car is 70% more likely to be killed in an accident with a large truck than in an accident with a car.

The type of truck accident is dependent on the circumstances surrounding the accident site. The seriousness of the accident and the severity of injuries sustained also depend on the type of accident.

Some accidents result in minor injuries, whereas there are others which can cause debilitating and life altering injuries and even death.

Types of Truck Accidents include the following:

Jack-Knife Accidents

This type of accident happens when the brake of the drive axle of the tractor-trailer locks up causing the trailer to start skidding. The skidding of the trailer stops only when the tractor and the trailer are at a 90-degree angle. During this skid, the driver does not have any control over the truck and any vehicle which gets stuck in the 90-degree angle can get dragged along. The truck, generally, tends to roll over after it comes to a stop.

Roll-Over Accidents

A truck rolling over its side or roof can have disastrous consequences for the truck driver as well as the occupants of any other vehicle getting stuck under the truck. A truck may roll over due to various factors such as high speed, sudden braking, steep incline or decline, taking a turn too fast, tripping over a curb, an obstruction on the road, or attempting to correct a drifting truck.

Rear-End Collisions

Large trucks, due to their large size and heavy weight, require a much larger distance to come to a complete stop after the application of the brakes. If the driver has miscalculated the distance, the truck can end up hitting the rear end of the vehicle in front.

Under-Ride Collision

This happens when a smaller vehicle crashes into a truck from behind or the side. Due to the size difference, the smaller vehicle can get stuck under the truck causing severe head injuries to the driver and passengers of the car, which may be fatal.

Road Construction Accidents

A truck driver may face difficulty in maneuvering a truck through a construction zone. An accident like a collision or a roll-over is extremely hazardous for the construction crew and small vehicle getting stuck in the way of the truck.

Contact the Texas Truck Accident Lawyers at Miller Weisbrod
If you or a loved one has been involved in an accident with 18-Wheeler semi-truck, seek help from the experienced Texas truck accident lawyers of Miller Weisbrod. We can help you receive compensation for your medical expenses, damages incurred, lost wages, and pain and suffering. Contact us today at (214)987-0005, or if you are outside the DFW area, call (888) 987-0005.

Tuesday, February 23, 2016

Traumatic Brain Injuries

Also known as “TBIs,” traumatic brain injuries are exactly what they sound like: serious injuries to the brain. Lately, TBIs have received more attention, especially due to the lawsuits filed by football players.

While sports injuries, including repetitive concussions, are known causes of traumatic brain injuries, automobile accidents are another major cause of TBI’s. The most widely reported brain injuries from car wrecks result from vehicle rollovers or occupant ejection. These often lead to catastrophic brain injuries, including skull fractures and other similar major traumatic injuries.

Surprisingly, a much more common cause (though under-reported) is from a rear end collision. Most of these brain injuries do not involve an obvious trauma like a skull fracture or facial wound. The mere serious whiplash of the head back and forth due to a violent rear-end collision can cause a life altering brain injury (physicians refer to this injury as a “Contra-Coup” injury (where the brain contacts the front of the skull and back of the skull due to the whiplash forces).

A Contra-Coup TBI can injure blood vessels in the brain and cause a slow bleed, which can create pressure that contributes to brain damage and even death. Or the bleeds and tears may be microscopic in nature, but nevertheless have serious consequences on the higher (executive level) functioning of the brain.

These injuries cause the neurons (transmitters) of the brain not to be able to relay the electrical messages of the brain as efficiently or quickly—leading to problems with memory, problem solving, emotion control and impulse control. These injuries can have lasting consequences.

Symptoms of a traumatic brain injury include:
1. Loss of Memory
2. Lack of Sleep
3. Dizziness
4. Balance Problems
5. Headaches
6. Fatigue

If you notice any of these symptoms, or if you just can’t think clearly after a car accident, then seek medical attention immediately. You should also consult a personal-injury attorney as soon as possible.

Miller Weisbrod has dozens of million and multi-million dollar verdicts and settlements on behalf of clients who have suffered all levels of TBI. Our demonstrated trial experience and proven record of results are just some of the many reasons clients continue to turn to us in their time of need.

Among other notable cases, Miller Weisbrod recovered $4,250,000 on behalf of a passenger in a truck who suffered a catastrophic brain injury as a result of being forcibly ejected from a truck in a serious motor vehicle accident as well as $1,500,000 for a client injured in a construction/worksite accident after falling from an unstable work platform

Contact Us
To schedule a free case evaluation regarding your TBI injury, please contact our office in Dallas at 214.987.0005 or toll free at 888.987.0005. You may also contact us by e-mail today for prompt answers to your questions or to schedule an appointment.

What to Look for When Searching for a Personal Injury Lawyer

Someone who decides to find a personal injury lawyer wants to choose the best person for the job. The person may have been injured in a car accident that wasn’t his or her fault. Consequently, the individual needs a lawyer who will help with the process of getting compensation. Take a look at a few things to consider before hiring a personal injury lawyer.

A Lawyer with Experience
Experience is one of the most important qualifications of a personal injury lawyer. In Texas, there is a Board that certifies lawyers who have actually tried cases and shown exceptional skill in passing a rigorous certification examination; these lawyers are Board Certified in Personal Injury Trial Law. A lawyer that has the required number of trials and the skills to become Board Certified are known to the insurance companies and increase the odds getting the best outcome for clients.. A person who is seeking compensation in a personal injury case will feel more at ease working with an experienced and qualified lawyer. Miller Weisbrod is an example of a firm with professionals who have experience with personal injury cases.

A Record of Success
Someone looking for a personal injury lawyer should also find out if the professional has a record of success with these types of cases. A record of success stands as proof that a lawyer has the qualifications to win a person’s case. Miller Weisbrod has an extensive track record in obtaining multi-million dollar verdicts and settlements for victims and their families. The attorneys at Miller Weisbrod are recognized leaders in plaintiffs’ personal injury trial law. Our experience, substantial resources, and proven litigation skill enables us to handle complex cases nationwide.

A Lawyer Who Focuses on Clients
A personal injury lawyer should be client-focused. This means that the lawyer returns a client’s phone calls and emails in prompt fashion. Also, the lawyer updates a client on the status of his or her case. A client-focused lawyer answers all of a client’s questions. Most people aren’t familiar with the process of going through a personal injury case. That’s why it’s necessary to have a lawyer who is willing to take the time to explain the various stages of the process.

A Lawyer that has the resources to take on the big corporations and insurance company
Clients in serious personal injury cases need a law firm that has the financial resources to take on the biggest insurance companies and the largest corporations. These companies will spare no expense in defending themselves. A personal injury victim should have a firm that puts them on equal footing with the person/entity that caused their injuries.

Finally, some personal injury cases take a long time to work their way through the court system. That’s why it’s important to consider all of the qualifications and resources of a lawyer before deciding to hire one. Someone who is trying to get compensation for an injury needs a lawyer who is dedicated to getting the best possible results for his or her clients.

If you were hurt or a loved one died, make the call to the experienced team that can act quickly to set you on the road to recovery. Call Miller Weisbrod, LLP toll free at 888.987.0005 for a free consultation.

Distracted Driver Attorneys in Dallas

The National Safety Council (NSC), estimated that during 2013, 35,200 people died in traffic accidents in the United States. In addition, the estimate included 3.8 million crash injuries requiring medical attention.

Driving while distracted has surpassed intoxicated driving deaths for the past seven years.

3 Leading Causes of Fatalities on the Road
The National Safety Council’s latest annual report, “Injury Facts® 2014”, illustrates details on “unintentional injuries” and the three most significant causes of fatalities on the road. The first two have been traditional ongoing problems for decades while the third leading cause is a new phenomenon due to the rapid advancement in technology:

Alcohol – 30.8%
Speeding – 30.0%
Distracted driving – 26.0%

10 Distracted Driving Habits That Lead To Accidents
“Distracted driving is any activity that could divert a person’s attention away from the primary task of driving. All distractions endanger driver, passenger, and bystander safety.”

• Texting
• Cell phone or smartphone usage
• Using a navigation system
• Allowing pets to ride in driver’s lap or arm rest
• Eating and drinking
• Reading, including maps
• Grooming
• Talking to passengers
• Adjusting a radio, CD player, or MP2 player
• Watching a video

Distracted Driving Statistics
Although teen drivers are the most susceptible group to distracted driving, nearly every age group participates in some type of distracted driving habits. According to Distraction.Gov, “An estimated 421,000 people were injured in motor vehicle crashes involving a distracted driver in 2012.”

Some alarming statistics about distracted driving:
• 10% of all drivers under the age of 20 involved in fatal crashes were reported as distracted at the time of the crash. This age group has the largest proportion of drivers who were distracted

• Drivers in their 20s make up 27 percent of the distracted drivers in fatal crashes – National Highway Traffic Safety Administration

• At any given daylight moment across America, approximately 660,000 drivers are using cell phones or manipulating electronic devices while driving, a number that has held steady since 2010 – National Occupant Protection Use Survey

• Five seconds is the average time your eyes are off the road while texting. When traveling at 55mph, that’s enough time to cover the length of a football field blindfolded – VTTI

• 25% of teens respond to a text message once or more every time they drive. 20% of teens and 10% of parents admit that they have extended, multi-message text conversations while driving – University of Michigan Transportation Research Institute

Contact Us
If you were seriously injured, or a loved one died in a car accident caused by distracted driver, call the offices of Miller Weisbrod, LLP, located in Dallas, today at 214.987.0005 or toll free at 888.987.0005 for a free consultation with an experienced personal injury trial attorney. You may also contact us by e-mail for answers to your important questions or to schedule an appointment.

Monday, February 22, 2016

Traffic deaths jump by most since 1966

Traffic fatalities increased in 2015 by an amount not seen in 50 years. Texas, which has the deadliest highways in the country, remained largely unchanged.

The National Safety Council on Wednesday announced preliminary analysis showed 38,300 roadway deaths in the U.S. last year. That was an increase of 8% from 2014, the highest year-to-year since 1966.

Texas led the nation with 3,490 deaths on roads and highways. Despite California having roughly 12 million more residents, it had 240 fewer traffic deaths.

Texas’ fatality trend was stable. The number of deaths increased 1% from 2014 to 2015 and 4% from 2013 to 2015.

The report notes a recent push in Houston to improve traffic safety. Houston had more roadway deaths than New York, which is roughly four times Houston’s size.

Houston’s economic growth has meant more vehicles on the road, the local analysis concluded, and a corresponding jump in traffic fatalities.

The same conclusion was painted by the National Safety Council report. As vehicle miles traveled have increased in the U.S. and gasoline prices dropped, roadway deaths increased.

The National Safety Council data is different from fatality reports analyzed by the National Highway Traffic Safety Administration because NHTSA considers fatalities within 30 days of the roadway crash, while the safety council logs all deaths within one year of the incident.

Though drivers log more total miles on urban roads and freeways, nearly half the increase in traffic deaths occurred on rural roads.

Contact Us
If you were seriously injured, or a loved one died in a car accident caused, call the offices of Miller Weisbrod, located in Dallas, today at 214.987.0005 or toll free at 888.987.0005 for a free consultation with an experienced personal injury trial attorney. You may also contact us by e-mail today for answers to your important questions or to schedule an appointment.

Friday, February 19, 2016

Neonatology Gives Back What Obstetrics Take Away

It is well-known that hypoxic and/or ischemic events during labor and delivery can cause injury to the baby's brain. The mechanisms at first blush appear to be reasonably straightforward. On closer examination, the pathophysiology of such injuries is actually quite complex. To be sure, the primary energy failure associated with lack of oxygen during labor and delivery can and does cause injury to fetal brain tissue. It may well be, however, that the greatest amount of injury to the neonatal brain occurs over time through a complex series of mechanisms put into motion by the initial insult. This being the case, it is possible that all or a substantial part of the injury to the brain can be avoided if the appropriate steps are taken to interrupt the process.

For years, nurses and neonatologists were in agreement that it was bad to let a sick baby get cold. Accordingly, protocols developed to quickly dry newborns and put them in an infant warmer. By the same token, for thousands of years, medical practitioners have attempted to relieve all sorts of maladies by cooling.

Throughout the world, there were numerous accounts of people who survived tragic events intact, apparently as a result of cold conditions. For example, most have heard of accounts where a near drowning victim survived intact in icy water. The development of the use of cardioplegia during open-heart surgery demonstrated that a lengthy post hypoxic cascade of molecular and cellular processes could be interrupted to protect the human body from ultimate cell death. This raised serious questions as to whether hypothermia after hypoxia could possibly reduce brain injury.

Throughout the 90’s, numerous studies demonstrated that hypothermia had potential as a neuroprotective therapy following a hypoxic event. This culminated first in pilot clinical trials, and then large randomized trials, establishing the efficacy of hypothermia as a neuroprotective treatment following a hypoxic ischemic insult during labor and delivery.

In December 2006, the FDA granted pre-market approval to the Olympic Cool Cap Device, setting forth the criteria for selective cooling with mild hypothermia to prevent or reduce the severity of neurologic injury associated with hypoxic ischemic encephalopathy.

The criteria for the therapy included physiologic evidence of intrapartum hypoxia. Since then, both head cooling and whole body cooling have become standard throughout the United States. Most hospitals which provide therapeutic hypothermia use essentially the same criteria as were used in the initial studies. Importantly, it is a widespread belief that to be effective, the therapy must be initiated within six hours of birth, the earlier the better.

The initial studies were not surprisingly animal studies, primarily pigs, rats and sheep. And the studies showed promise. The following table (Levene, 2002) summarizes many of the studies throughout the 1990’s:
Model Hypothermic Treatment Outcome after hypothermia References
7-day-old rats, unilateral carotid artery ligation + 8% O2  for 3 h Environmental temperature was reduced from 37 to 34 or 31˚C for 3 h; hypothermia induced either during the hypoxia or immediately after hypoxia

Brief reductions in temperature of 3 - 6˚C had neuroprotective effects if initiated during, but not after, the insult.

Percentage damage in the ipsilateral hemisphere was reduced from 45.5 to 0% in hypothermic animals
Yager et al. (1993)
7-day-old rats, unilateral carotid artery ligation + 8% O2 for 3 h 30˚C  vs 37˚C started immediately after insult Percentage damage in the ipsilateral hemisphere was reduced from 45.5 to 0% in hypothermic animals Saeed et al. (1993)
9- day-old piglets, neck compression + hemorrhagic hypotension (15 min) Intraischemic temperature reduced from 38 to 35˚C (rectal temperature) Partial neuroprotection with reduced damage in areas of cerebral cortex and caudate nucleus Laptook et al. (1994)
7-day-old rats unilateral carotid artery occlusion + hypoxia Focal cooling with ipsilateral scalp temp of 22-35˚C vs. 37˚C for 2 h during the hypoxia Cooling of less than 28ͦC completely protected the brain from damage, neuropathology 3 – 4 days after insult Towfighi et al. (1994)
1-day-old piglet, bilateral carotid artery occlusion + hypoxia
34.9˚C vs. 38.5˚C (tympanic membrane temperature) for 12 h, initiated immediately after resuscitation
No difference in necrotic cell numbers, but the number of apoptotic cells was reduced
Edwards, et al. (1995)
Newborn piglet, transient bilateral carotid artery occlusion + hypoxia (45 – 98 min) Hypothermia (35˚C, tympanic) initiated at the time of resuscitation and maintained for 12 h Energy ratios 24 – 48 h after insult were maintained at a similar level to sham control animals, no pathology Thoresen, et al. (1995)
21-day-old rats, unilateral carotid artery ligation + 8% O2 for 15 min Animals were treated with post-ischemic environmental hypothermia (22˚C) for either 0 – 6 h, 6 – 72 h or 0 – 72 h. This resulted in a 2˚C reduction in brain temperature (38 - 36˚C) Neuroprotection was only seen after prolonged (0 – 72 h) post-ischemic hypothermia.  Protection was still evident after 3 weeks. Sirimanne et al. (1996)
7-day-old rat, bilateral carotid artery ligation + 80% O2 for 2 h Hypothermia (from 38˚C vs. 32˚C, rectal temperature) for 3 h, started immediately, after hypoxia-ischemia Hypothermic animals had a 65% reduction in histological brain damage Thoresen et al. (1997)
Piglets (<2 weeks old), 15  min hemorrhage and four-vessel occlusion Hypothermia 36˚C vs. 38˚C (rectal) for 1 h, started immediately after the insult Reduced neuronal damage at 72 h in temporal and occipital cortex and caudate nucleus Laptook et al. (1997)
Newborn piglets Hypothermia: 35˚C vs. 39˚C, initiated on resuscitation Reduced release of excitatory amino acids and NO in the cortex after hypothermia Thoresen et al. (1997)
Newborn piglets, Fio2  6% or higher, depending on arterial pressure and pulse rate aiming at low-voltage EEG.  Total hypoxic duration approximately 45 min Cooling for 3 h (35˚C vs. 39˚C), started immediately after the insult After 3 days, there was no overall improvement in histological outcome.  Hypothermia was, however, protective after adjustments for differences in severity of insult and post hypoxic seizures. Hypothermia improved neurologic score and recovery of EEG at some time-points Haaland et al. (1997)
7-day-old rats, unilateral carotid artery ligation + 8% O2  for 75 min 32˚C vs. 35˚C vs. 38˚C for 3 h started immediately after HI The brain damage was delayed but was similar to normothermic animals after >1 week recovery Trescher et al. (1997)
Newborn piglets, bilateral carotid artery ligation + hypoxia (31 – 98 min) Cooling (rectal temperature 35˚C) began at the time of resuscitation and was maintained for 12 h Reduced rise of lactate during secondary phase as measured by MRS Amess et al. (1997)
7-day-old rats, bilateral carotid artery occlusion + 7.7% O2  for 70 min Hypothermia (rectal temperature 32˚C) was induced for 6 h immediately after hypoxia-ischemia Long-term (6-week) 30% reduction of injury was observed in cerebral cortex, hippocampus, basal ganglia and thalamus.  No effect on sensory-motor function Bona et al. (1998)
Fetal sheep, 30 min bilateral carotid artery occlusion Delayed cooling from either 1.5-72 h or from 5-22 h after ischemia, i.e. hypothermia started before postischemic seizures. Extradural temperature reduced from 39 to 30-33˚C Reduction in neuronal loss in cerebral cortex from 40 to 99%

Gunn et al. (1997)

Gunn et al. (1998)
Fetal sheep, 30 min bilateral carotid artery occlusion Delayed cooling from I to 72 h after ischemia, i.e. hypothermia started after postischemic seizures. Selective head cooling 39˚C vs. 30-33˚C (extradural temperature) No neuroprotective effects were observed Gunn et al. (1999)
The animal studies led to human trials (Azzopardi, et al, Pediatrics 2000). The first large randomized trial was the Cool Cap Study, which looked at selective head cooling for 72 hours for enrolled babies with asphyxia, signs of encephalopathy and abnormal aEEG's. This trial showed a reduction in death or disability at 18 months for babies with less severe EEG changes at the time therapy was initiated (Gluckman, et al, The Lancet, 2005). The next study was conducted by the U.S. National Institute of Child Health and Development Network. It used whole body cooling, showing significant reduction in death or disability (Shankaran, et al., N Eng J Med, 2005). The total body hypothermia trial (TOBY) was another whole body cooling study. It showed a significant increase in survival and decrease in neurologic injury (Azzopardi, et al., N Eng J Med 2009). All three of these early trials have been followed and have established evidence that the protection at 18 months lasts into the school years. A meta-analysis of the trials has confirmed that hypothermia works. It reduces both disability and death in babies who have suffered a hypoxic ischemic event during birth (Jacobs, et al., Cochran Data Base Syst. Rev. 2013).

The criteria for therapeutic hypothermia are reasonably straightforward. It should be noted that the criteria for treatment are far different from what ACOG has tried to sell as the necessary criteria to establish HIE during labor and delivery. And the criteria are essentially the same throughout the country. In the main, they have remained unchanged. Not surprisingly, the criteria are often suggested by the manufacturer’s recommendation. In granting pre-market approval for the Olympic Cool-Cap, the FDA set forth the following criteria in 2006 (FDA letter to Olympic Medical, December 20, 2006):

Clinical evidence of moderate to severe HIE is defined as meeting criteria A, B and C below:
A. Infant at greater than or equal to 36 weeks gestational age (GA) and at least one of the following
• Apgar score less than or equal to 5 at 10 minutes after birth
• Continued need for resuscitation, including endotracheal or mask ventilation, at 10 minutes after birth
• Acidosis defined as either umbilical cord pH or any arterial pH within 60 minutes of birth less than 7.00
• Base Deficit greater than or equal to 16 mmol/L in umbilical cord blood sample or any blood sample within 60 minutes of birth (i.e., arterial or venous blood)

B. Infant with moderate to severe encephalopathy consisting of altered state of consciousness (as shown by lethargy, stupor or coma) and at least one of the following:
• Hypotonia
• Abnormal reflexes, including oculomotor or papillary abnormalities
• Absent or weak suck
• Clinical seizures

If the infant is paralyzed, assume an abnormal evaluation for criteria B and proceed to criteria C.
C. Infant has an amplitude-integrated electroencephalogram/cerebral function monitor (aEEG/CFM) recording of at least 20 minutes’ duration that shows either moderately/severely abnormal aEEG background (score of 2 or 3) or seizures.

Note: The aEEG/CFM should be performed after one hour of age and should not be performed within 30 minutes following intravenous (IV) anticonvulsant therapy as this may cause suppression of EEG activity.
The aEEG/CFM score is determined as follows:
1a Normal: Lower margin of band of aEEG activity above 7.5 microVolts (µV); sleep-wake cycle present. (Cool only if seizures are present)
1b Mildly abnormal: Lower margin of band of aEEG activity above 5 microVolts µV; sleep-wake cycles absent. (Cool only if seizures are present)
2. Moderately abnormal: Upper margin of band of aEEG activity above 10 µV and lower margin below 5 µV.
3. Severely abnormal: Upper margin of band of aEEG activity below 10 µV and lower margin below 5 µV,
4. Seizures: Seizures on the aEEG are characterized by a sudden increase in voltage accompanied by narrowing of the band of aEEG activity and followed by a brief period of suppression.

If all three criteria are met, cooling should be started within six hours of birth.

Another rendition of the criteria for cooling eligibility is set forth. It is essentially the same (Mossali 2012):
Eligibility Criteria for Infant Cooling
Infants of gestational age greater than or equal to 36 weeks must meet both physiological and neurological criteria
Physiological Criteria
Evidence of intrapartum hypoxia, including at least two of the following:
1. Apgar score 5 or less at 10 min.
2. Needing mechanical ventilation and/or ongoing resuscitation at 10 minutes
3. Metabolic or mixed acidosis defined as arterial cord gas, or any blood gas within the first hour of life showing pH of 7 or less, or base deficit of ≥12 mmol/l.

Other qualifying criteria
If no cord blood gas is available and the initial blood gas within 60 min of birth shows a potential pH of <7.10 with a base deficit of ≥ 16 mmol/l, plus an acute perinatal event (abruption placenta, cord prolapse, or severe fetal heart rate (HR) abnormalities, variable or late decelerations) requires resuscitation, plus either (a) or (b).
a) Apgar less than 5 at 10 min
b) Continued need for ventilation initiated at birth and continued for at least 10 min.

Neurological criteria
One of the following:
1. The presence of seizures is an automatic inclusion
2. Evidence of encephalopathy suggested by amplitude-integrated EEG (a-EEG)
3. Physical examination consistent with moderate to severe encephalopathy

Hospitals offering therapeutic hypothermia available for treatment have their own criteria, which have little variation. These criteria are no secret. They are often published on the hospital’s website or even on their You-Tube presentations. These are for marketing purposes and worth viewing. They are often generous about the likely outcome from their therapy. Note also that most treating hospitals have sent correspondence to all of the referral hospitals in their catchment area. These letters are an effort to generate referrals and are worth getting if therapeutic cooling is an issue in a case.

All of the criteria reviewed include reference to Apgar scoring. Although cooling was not at issue in the 50’s, when Virginia Apgar suggested the scoring system, it has been used in evaluating neonates as a standard part of newborn care for decades (Edwards 2013):
  0 1 2
Heart rate(pulse) No pulse felt Less than 100 Greater than 100
Respiratory Effort Apnoea Irregular, shallow ventilation Breathing/crying
Reflex irritability (grimace)* No response to stimulation Grimace/feeble cry when stimulation Sneeze/cough/pulls away when stimulated
Muscle tone (activity)* Flaccid Good tone Spontaneous movement
Colour (appearance)* Blue/white Partially pink Entirely pink

*The Apgar mnemonic introduced as a teaching tool in 1963 by Dr. Joseph Butterfield

The degree of neurologic insult suggesting encephalopathy is another part of the criteria. It is determined through either an aEEG or through physical examination. The physical examinations typically refer to a moderate or severe encephalopathy. Typically, they are using the Sarnat grading scale for encephalopathy. It gives a consistent method of evaluation and is easy to apply.
the Sarnat grading of encephalopathy (Edwards 2013):
Measure Sarnat Grade
  1 2 3
Conscious level Hypoalert Lethargic Stupor
Muscle tone Normal Hypotonic Profound hypotonia
Posture Mild distal flexion Strong distal flexion Decerebrate
Stretch reflexes Normal Overactive Overactive
Moro reflex Strong Incomplete Absent
Suck reflex Normal Weak Absent
Tonic neck reflex Slight Strong Absent
Pupils Dilated Constricted Poorly reactive
Gut motility Normal Increased Variable
Seizures Uncommon Focal or multifocal Generalized
The outcome probabilities for cooling are often measured by whether the baby is mildly, moderately, or severely encephalopathic before and after treatment. Again, this is typically measured by evaluating the child using the Sarnat Scale. As a general rule, the studies show the therapeutic hypothermia is potentially helpful. Importantly, if a baby is cooled in a timely fashion and is a Sarnat one or two at the time of cooling, more likely than not, the baby’s outcome will be better. For example, the NICHD and Cool Cap.

Trials study show:
Proportion of Infants with Moderate and Severe Encephalopathy with Primary Outcome of Death and Disability in the NICHD and Cool Cap Trials.
(Shankaran, et al, Optimizing Cooling for HIE, NICHD Neonatal Network, 2010):
Whole body Hypothermia

NICHD trial (Shankaran 05)
32% 48%
Cool Cap trial (Wyatt 07) 45% 57%
Whole body Hypothermia

NICHD trial (Shankaran 05)
72% 85%
Cool Cap trial (Wyatt 07) 70% 91%
The primary mechanism of cell death from an asphyxia event is initiated by oxygen and glucose deprivation and an impairment in energy supplies. This primary or acute phase of injury typically begins within minutes. It includes the depletion of energy metabolites and a switch to anaerobic metabolism with a rapid depletion of adenosine triphosphate (ATP). There is a rapid depolarization of cells, the initiation of cytotoxic edema, an increase in intracellular calcium, sodium overload, increase in extracellular glutamate and progressive acidosis, leading to cell injury and necrotic cell death.

Notably, the cascade of deleterious events that lead to cell death after a hypoxic ischemic insult that results in energy failure appears to occur following the termination of the insult during the reperfusion. After cerebral circulation and oxygenation are restored, there is a slow reduction of the metabolic acidosis. This is clinically shown by a reduction in cytotoxic edema and the reduction of the excitatory amino acids that are initially accumulated in the extracellular space. While cell death does occur during the primary phase after a sentinel event, it is often the later, latent phase of the insult which leads to global damage. Hours after the primary insult and restored perfusion, the secondary or latent phase includes secondary cytotoxic edema, inflammatory responses, an increase in free radical release and calcium overload. The accumulation of excitatory amino acids leads to neuronal cell death through apoptosis (Volpe, Neurology of the Newborn, 5th Ed; Edwards, et al., 2013).

As the precise mechanism of hypoxic ischemic cell death is not fully understood, nor is the precise mechanism of hypothermic neuroprotection. Pragmatically, it appears effective. Broadly, it seems well-established that cooling interrupts or at least suppresses many of the pathways leading to a hypoxic cell death.

Hypothermia certainly reduces cellular metabolic demands. It also reduces excessive accumulation of cytotoxin's and oxygen free radicals. It suppresses the post ischemic inflammatory process and seems to inhibit the intracellular pathway leading to apoptosis delayed programmed cell death (Edwards, et al. 2013).

Neuroradiologic Imaging
Therapeutic hypothermia initiated within the first six hours of life is done so with the intent that it diminish or prevent acute brain lesions. The longer-term effects of cooling on the evolution of brain lesions have not been well studied. Predictably, some studies have reflected a decrease in both white matter and basal ganglia and thalamus lesions. But in the main these have not been controlled trials. An imaging study was performed within the TOBY trial. It showed that there was such a decrease (Rutherford 2010). At least one study has shown that cooling did affect the timing of the evolution of the injury, as reflected on MRI. It appears that therapeutic hypothermia delays the return of mean diffusivity ratios to normal, which is pseudo-normalization, until after the 10th day, as compared to the more typical 6 to 8 days. Accordingly, it appears that cooling slows the evolution of diffusion abnormalities as shown on MRI, (Bedrick 2012).

Unanswered Questions
There remain many unanswered questions as the science of brain injury and neuroprotection are evolving. In addition to finding the precise timing and temperature for therapeutic hypothermia, there are other potential therapies that could be used in combination with hypothermia in an effort to optimize results. Obviously, antiepileptic drugs are used frequently to control seizures that attend an ischemic injury. Other adjuvant therapies show some promise, particularly given what we know now about the mechanisms of injury. For example, antioxidants, such as allopurinol and N-Actylcysteine are being studied.

Additionally, other therapies such as magnesium sulfate, Alpha 2 - adrenergic agonists, melatonin, and a variety of anesthetics are being looked at as well (Edwards, 2013). Implementation of clinical trials for future combination therapy has many practical problems, not the least of which is the expense. Moreover, it will be initially difficult to discern the incremental benefit from such adjuvant therapies. Another area of research is in the design of studies to determine “optimal" outcome. To be sure, using Sarnat scales and subsequent neuropsychological testing, hypothermia has been shown to yield “better" outcomes. To date, however, "better" defies a precise definition in a given case.

Wednesday, February 17, 2016

Aqua Rug Product Recall

A lawsuit has been filed in a U.S. District Court, alleging that both QVC and Tristar Products, Inc. were aware of the dangers before consumers purchased the Aqua Rug. The, now-recalled, bath mat is marketed as a slip-proof bath mat.

"Aqua Rug", manufacturer Tristar Products, Inc. has been sued in federal court over allegations the non-slip bath rug was prone to slippage.

The lawsuit seeks monetary damages for liability, negligence and breach of warranty.

An estimated 1.4 million of the rugs, those manufactured between July 2012 and September 2015, were recalled within days of the lawsuit’s filing. The products were widely available, not sold exclusively by QVC.

The Aqua Rug has been purchased from the following providers:
• Bed Bath & Beyond
• Dollar General
• Tristar Products, Inc. -Through direct response television commercials, and live television on QVC

Consumers should immediately stop using the recalled shower rugs and contact Tristar for instructions on how to dispose of the rugs and to obtain a free replacement rug.

The complaint includes 40 online customer complaints saying that the suction cups didn’t stick, that the rugs didn’t stay in place or that they posed a danger of falls.

This recall involves Aqua Rugs with four plastic suction cups. The rugs are intended to provide a slip-resistant surface in the shower or bathtub. The rugs were sold in beige and clear, and in two sizes: 29.5 inches by 17.25 inches for use in the bathtub, and 21.75 inches by 19.75 inches for use in a shower stall.

The rugs have a plastic border and only four plastic suction cups, one affixed to the underside of each corner of the rug. “Aqua Rug” and “As Seen On TV” are printed on the front of the cardboard packaging.

Tristar Products, Inc. has received 60 reports of consumers falling in the shower or bathtub while on the recalled four suction cup rugs, including 30 reports of injuries such as bruises, cuts, and fractured or broken bones.

QVC spokeswoman, Diane Zappas, sent a response via email about the lawsuit, noting that the Aqua Rugs were recalled and that customers can get a free replacement of their 4-suction-cup rugs by following instructions at the link provided below:

Tristar Products Recalls Aqua Rug Shower Rugs

Federal law bars any person from selling products subject to a publicly-announced voluntary recall by a manufacturer or a mandatory recall ordered by the Commission.

At Miller Weisbrod, LLP, we help victims of defective consumer products nationwide. We have the experience and resources to take on major manufacturers of defective products in pursuit of maximum financial compensation for our injured clients and families who have lost a loved one from a defective product.

Manufacturers and distributors of defective products may be held legally liable to pay for damages if their product causes injury to a consumer. The capable attorneys of Miller Weisbrod have a proven record of success in obtaining substantial insurance settlements and jury awards for victims of defective products for the home or workplace.

Contact Us Today
If you were injured or a loved one died due to a defective consumer product, we encourage you to call our offices in Dallas today at 214.987.0005 or toll free at 888.987.0005. You may also contact us by e-mail today for prompt answers to your questions or to schedule an appointment.

Monday, February 15, 2016

What are the most common injuries seen in car crashes?

People are injured every day in car, truck and motorcycle accidents. The type and nature of any injury is dependent on the specific facts and dynamics of the crash. Over the years, we have noted most common injuries following a wreck:

Head Trauma: This occurs when the head strikes an object in or outside the vehicle. The head can be traumatized by the roof, windshield, side window, rear window, seats or steering wheel. Trauma to the head can cause a fracture to the bones of the skull or bleeding just under the skull.

Brain Trauma: Injury to the brain can be one of the most devastating injuries to a person after an accident and many times the injured person doesn't realize it until months or years following the crash. The brain is suspended in the skull by fibrous tissue (ligaments) and is bathed in cerebral spinal fluid. (If the victim's head is jerked forward and backwards or hits a stationary object the brain can collide with the inside of the skull causing bruising and damage to nerve cells).

Whiplash: If a car is rear-ended, the quick, forceful impact can cause the occupant's head to jerk backwards and forward. This may cause injury to the soft tissues of the neck (muscles, ligaments, discs). These people can feel neck pain, arm pain, upper back pain and/or headaches.

Spinal Cord Injury: A spinal cord injury may lead to loss of function in the injured person's arms and/or legs depending on the nature extent of damage to the spinal cord. Along with brain injuries, this is one of the most serious types of car accident injuries one may experience.

Upper Extremity Injury: The shoulder, elbow, wrist or hand can be injured in accidents from either direct or indirect trauma. We typically see rotator cuff injuries, fractured forearms and wrist bones because the driver is holding onto the steering wheel or a passenger puts their hands on the dashboard to brace themselves during the crash.

Lower Extremity Injury: A person's hips, knees, ankles or feet can be injured in an accident from blunt force trauma. We typically see knee injuries when peoples' knees are pushed into the dashboard, steering wheel or seat back. We see hip injuries from side impact and front impact collisions and ankle injuries when a person leg is jammed against the brake pedal or foot board.

Internal Injuries: If an accident is forceful, an occupant of the vehicle may experience injury to internal organs. For example, rib fractures can injure the lungs, heart or spleen.

Why Miller Weisbrod?
At Miller Weisbrod, LLP, we focus on results. In our many years of practice, we have developed an in-depth knowledge and familiarity with the structure and design of automobiles and auto parts, which we bring to bear on every case we handle.

We have recovered many million and multimillion dollar verdicts and settlements on behalf of clients who have suffered TBIs. Our demonstrated trial experience and proven record of results are just some of the many reasons clients continue to turn to us in their time of need.

Among other notable cases, Miller Weisbrod recovered $4,250,000 on behalf of a passenger in a truck who suffered a catastrophic brain injury as a result of being forcibly ejected from a truck in a serious motor vehicle accident.

Contact Us
Our attorneys offer sound legal advice, experienced representation and dedicated advocacy to victims of auto accidents and their families. For more information, we invite you to contact our offices in Dallas at 214.987.0005 to schedule a free initial consultation with our experienced personal injury trial lawyers.

If you are calling from outside the DFW Metroplex, please call us toll free at 888.987.0005. You may also contact us by e-mail now for prompt attention or to request an appointment.

Tuesday, February 9, 2016

Miller Weisbrod Wins $3,000,000.00 Arbitration Award

One of the highlights of 2015 for Miller Weisbrod was a $3,000,000 Arbitration Award for a man that lost his right hand as a result of a work place injury. Greg Turner was working at a local chocolate/candy factory operating an industrial chocolate mixer. While dumping melted chocolate from plastic buckets while the mixer was turning, he accidentally dropped a bucket into the mixer. Turner then reflexively reached into the mixer to retrieve the bucket. The blades of the mixer caught Turner's right hand taking it into a pinch point on the side of the mixer severing the hand at the wrist. A surveillance video caught this incident partially on tape — though the point of operation was obscured by the lid of the mixer.

Surveillance image

Turner's employer was a non-subscriber to worker's compensation. The employer had an injury benefit plan but denied Turner benefits because a post-accident drug screen showed amounts of two drugs in his system. Our firm filed suit and the case was removed to arbitration because the plan signed off on by Turner included an Agreement to Arbitrate.

Our claims of negligence involved the failure of the mixer to have an adequate guard over the opening of the mixer or, more practically, to have a lock-out device on the mixer that would shut the mixer off when the lid was lifted. Through deposition questioning, the Defendant's supervisors admitted that it was not necessary to have the lid open and the mixer on and turning while loading the chocolate. Our position was that the machine should be loaded with the machine off-but the company had trained all employees to load the mixer while it was on and turning. In fact, the surveillance video showed Turner's supervisor watching him for an extended period of time loading the mixer while it was on and turning.

The employer claimed that risks of the mixer were open and obvious and that it had warned Turner of the risks of sticking his hands into the machine; therefore, there was no duty to take additional precautions. In support, they cited numerous cases in the premises liability context that affirmed this position. We took the position that the instrumentality (the mixer) was dangerous and this was a separate duty in the non-subscriber context. The arbitrator agreed with this argument and denied a "no duty" motion. The Texas Supreme Court has recently also agreed with our position in a similar case Austin vs. Kroger Co., 465 S.W.3d 193 (Tex. 2015)

The Defense hired two main experts including a safety expert arguing against the need for a lock-out device. This expert was revealed to have no experience in machine guarding and expressed some irrational opinions that we pushed on to destroy his credibility. The second expert was a well-known prosthetic expert who advanced the theory that Medicaid was the industry standard for reasonable of charges for prosthetics and arguing that instead of a myeo-electric hand our client should get a hook and a rubber hand. We showed that he had been "out of the game" as far as upper limb prosthetics and that his "opinion" that Medicaid was the industry standard for billing rates was not supported by anything other than his word and then at arbitration confronted him with a prior case where he had taken the opposite position when hired by the plaintiff.

Below are a couple of short examples of the deposition cross examination:

At the Arbitration we proved that all the co-employees who encountered Turner on the day of the incident found him not to be impaired — eliminating the drug screen argument.

At the end of the hearing, the Arbitrator issued an award finding negligence and damages in the amount of $3,044,888.33. Miller Weisbrod has partnered with law firms across the state of Texas on a referral and joint venture basis to pursue cases of catastrophic injury and wrongful death arising from construction and work site incidents. Miller Weisbrod would welcome the opportunity to work with you to obtain justice for your clients injured or killed on the job.

Miller Weisbrod,LLP is a national law firm specializing in catastrophic injury and wrongful death cases. Partners Clay Miller and Les Weisbrod have built the firm’s reputation with successful verdicts, settlements, appeals and favorable decisions across the country. With resources and finances available to take on the powerful interests that have caused harm, the firm is committed to providing quality representation for clients who are seriously injured and families of victims who are killed as a result of the negligence or misconduct of others. Miller Weisbrod has offices in Dallas and affiliate offices in Houston and Austin. For more information call (888) 987-0005 or visit

Monday, February 8, 2016

Crane collapse with numerous injuries & ruptured gas mains in NYC

In New York City on Friday morning, it was snowing with strong — though not exceptionally strong — winds at the time of the collapse. Winds at nearby La Guardia Airport were gusting to around 30 miles per hour from the north-northeast on Friday morning.

The city often experiences stronger winds than this, but it's possible that the wind was a factor if crane operators did not anticipate the conditions, and improperly aligned or failed to properly secure the crane in advance of the weather.

New York Fire Department is on the scene of a crane collapse in Manhattan. One fatality confirmed, two seriously injured are being reported.

First responders are on the scene as photos have started trickling out from the crash site, which is near West Broadway and Worth Street.

(image accredited to @NYCFirewire)

The workplace can be a potentially dangerous environment, no matter what type of job you do. Whether working on a construction site or in an industrial setting, a workplace accident can result in catastrophic injury or even death.

If you or a loved one has suffered a workplace accident, you should discuss your rights and options with an experienced personal injury attorney. Without experienced representation, you could settle for far less than you are entitled to.

At Miller Weisbrod, LLP, we offer informed counsel and experienced representation to clients in Texas and throughout the nation. To discuss your case in a free initial consultation with an experienced lawyer, please contact us to schedule an appointment.

As experienced trial attorneys, we understand the serious and potentially lifelong impact a catastrophic work injury can have. From amputated limbs to paralysis to traumatic brain injuries, we use our experience and resources to help clients recover just compensation from negligent parties for their medical expenses, lost wages, partial or permanent disability, and − most importantly − the pain and suffering they have endured.

Our experience includes:
• Construction accidents such as trench collapses, scaffolding falls and other accidents
• Warehouse accidents
• Inadequately guarded machines
• Lack of safety policies, e.g. lock-out/tag-out, etc.
• Accidents caused by defective machines or defective products
• Electrical accidents
• Oil field accidents
• Fires or explosions
• Delivery or commercial trucking accidents
• Other commercial vehicle accidents
• Accidents resulting from repetitive physical or psychological stress
• Slip-and-fall accidents and other issues of premises liability

Many employees who have suffered injury in a workplace accident find that insurance companies are often quick to offer settlements or pressure them into signing waivers that effectively limit their rights. Our attorneys have significant experience taking on big insurance companies or liable third parties, and defend our clients' right to receive full and fair compensation.

Contact Us Today
If you suffered a workplace accident or a loved one died due to someone's negligence on the job, we encourage you to contact us to discuss your real options for pursuing legal action in a free consultation. Call our offices in Dallas at 214.987.0005 or toll free at 888.987.0005. You may also contact us by e-mail today for prompt answers to your questions or to schedule an appointment.