CSI MEDBLOGS: NEW INFO, NEW QUESTIONS, ON THE DEATH OF VICTORIA SNELGROVE

The Boston DA's office will not release any information about the Victoria Snelgrove death until they complete their investigations.

I do have a few sources who told me the following:

1. The pepperball may have been "weighted" with bismuth for stability. This, obviously would add weight to the projectile.

2. There were two tiny "wings", one on either side of the ball, added for aerodynamic stability in flight (these could act as cutting agents)

3. The ball is said to have actually pierced Ms. Snelgrove's globe (the eyeball proper) and "penetrated her brain"

Given the above, I have been asked the following:

Do you still believe that it is impossible that Ms. Snelgrove died from this injury?

My Reply:

First, I never said that this mechanism of death was impossible, I said it would be fantastically improbable. There is a difference and it matters immensely when assigning culpability.

It is a little euphemistic, probably, to say that the pepper ball penetrated her brain. Bullets can penetrate the brain at that speed, but they are metal, not designed to explode on contact, and have an aerodynamic advantage due to their tapered points and roughly fusiform contour. Don't forget, the eyeball is situated on the front edge of the orbit which is an inverted pyramid filled with DENSE fat.

If we assume the above are true then what probably happened is that the pepper ball struck her globe (her eyeball) directly (face-to-face so to speak) and did not explode -- only because of the fantastic coincidence that it must have directly hit the pulpy eyeball without striking the hard, surrounding bony orbital rim!--then, because of the pepperball's little wings (the stabilization wings) it cut into the eyeball and burst inside the orbit proper when it contacted the dense fat.

This explosion then must have expanded and fractured the orbit bones thus propelling a piece of the back of the orbit (the pyramid tip) into the space just behind the orbit, at the base (underneath) of the brain. The next link in this absurdly unlikely sequence of events would be that THAT backwardly propelled bone fragment lacerated the carotid artery, which, at that anatomic location, is wending its way up, into the higher brain.

There is NO WAY that the ball itself could directly impact the brain tissue proper and kill her. Instead of proposing direct trauma, you have to ask HOW she died. If your brain gets contused, you don't die as a direct result of the contusion. I've seen people live with car stick shifts (to mention just one of many items seen) rammed through their foreheads into their brains and they lived.

THIS death was probably from hemorrhage of a lacerated carotid artery.

Despite the many unanswered questions surrounding this case, beat writers are coninuing to plagiarize, stereotype, and outright slander as some continue to report this now 2 week old incident as if they just realized what had happened.

I mean look at this article from the Marlborough Enterprise and this Newsday Editorial from a professor of criminal justice!

Professor -- you don't even know how she died? How can you cast aspersions, assign blame and... bloviate without looking into what happened any further than 2 week-old news stories, all of which say the same thing (as you, funny, did too!).

Okay reporters, I'm going to help you out. Here are some absolutely essential questions that must be answered before we DO or SAY anything about who is to blame, what the proper behavior in these situations should be and WHO WILL WE SUE??

You are all FREE to use these questions without attribution!

HERE ARE THE QUESTIONS:

Did anyone see Ms. Snelgrove fall to the ground when purportedly hit by the ball?

Was she unconscious before she hit the ground?

Did she hit her head directly when she fell?

Were there therefore scalp lacerations and where were they?

Was there any cerebral injury identified on the CT scan (or autopsy) that can be directly attributed to the FALL rather than the pepperball?

Did anyone try to resuscitate her while she was on the ground and what did they do to her?

How long did it take for EMT to get there?

Did EMT try to resuscitate her?

Did they start an IV?

Did they administer drugs? If so, which ones? Were they in radio communication with the ER docs? If so, what was the conversation?

Did they realize she was bleeding to death?

Did they hang blood in the ambulance?

Was she DOA? Who says? How do they know?

When she got to the ER did they treat her as a STAT cerebral injury or a STAT bleeding-to-death injury.

Who saw her in the ER? A nurse/ intern/ resident/ fellow/ MD?

How long was it (if ever) before she was seen by a neurosurgeon or an ophthalmologist?

How did they stabilize her? Did they hang blood?

Did they give her steroids (only recently found out to be the WRONG thing to do in cerebral injuries)?

Did they do any emergency neurological procedures on her?

What was their first assumption in the ER:

epidural hemorrhage?
subdural hemorrhage?
intracerebral hemorrhage?
none of the above?

(an epidural is a bleeding artery just outside the brain and is a dire surgical emergency; a subdural is a bleeding vein and can be observed for a while; the third of these is a bloody bruise right in the substance of the brain)

How long after she got to the ER was she pronounced dead?

Who drew the first set of bloods?

How long did it take to get these bloods back?

What was the hematocrit and hemoglobin (blood counts to detect bleeding)?

Given that the above may not be accurate in the setting of acute hemorrhage, were there secondary physiologic signs of depleted intravascular volume?

Were the rest of her routine bloods normal?

Did she die by cardiac arrest?

Was emergency CPR done on her before she died?

Was emergency CPR done on her at any time?

What diagnostic tests did they do (CT MRI Chest X ray; X rays of the skull or orbits)?

What is the chronology of the above examinations beginning at the time she arrived at the ER?

In regards to the autopsy:

Was the carotid artery lacerated?
Did she bleed to death?
Were there any abnormal collections of epidural/subdural/intracerebral blood?
Where?
Any venous injuries or bleeds?

What fractures were there?

Specifically address:
shpenoid bone
orbital walls
calvarium
skull base

Were any cranial nerves avulsed. esp II, III, IV, V, and VI? Address each.

Was there evidence of brainstem injury?

Any cerebral infarction?

Is the proposed final mechanism of death cardiac dysrythmmia? If not, what was it?

I can interpret any and all of any answers you can get to any of these questions. They are all of interest, really, because this girl could have died from any number of mechanisms and the fault could lie with: fate; the police; the EMTs; or the ER personnel; or ?

Comments

[Roger Hill]

Howdy all;

I’m no medical expert, but I do know something about paintballs. For fun, I use to fly my Radio controlled plane around while my buddies tried to shoot it down with their paintball guns. Normally, a paintball gun fires the ball at 300 feet per second or less. At this speed the paintballs would hit my plane and splatter on the outside. My plane was made of a tough Plastic, so it didn’t really do any damage, but it sure was fun for all.

One day my buddy got a new paint ball gun that was capable of adjusting the velocity of the paintball. So, he turned it up to 450 feet per second and proceeded to go about shooting at my plane as it flew over. I didn’t know he had done that, and to my surprise, upon inspection of the plane after it landed, large holes were shot completely through the wing. And to top it off, none of the holes had paint marks on them. It seams that at the higher velocity of 450 feet per second, the paintballs no longer exploded as designed, but instead blasted its way through the wing and remained in tack.

I understand that some other police are saying they will continue to use the Pepperballs guns, but less powerful versions that fire at a lower velocity. This makes me think that perhaps the cops gun that fired the killer Pepperball might have been some kind of high velocity gun and the Pepperballs might have failed to explode properly at those velocities.

One other thing, to make your paintballs last a long time some people freeze them. More than once my buddies playing in paintball tournaments have been hit by a frozen paintball because somebody didn’t give them enough time to thaw out. A frozen paintball is basically the same as a rock.

Well, that’s my 2 cents worth.

Roger Hill

[CodeBlueBlogMD]

Roger:

Thanks for your post. Despite not being a medical expert you have certainly touched on some key elements of this case.

Yes, the paintball probably entered Ms. Snelgrove's eye without exploding. It then must have exploded INSIDE of her eye socket.

But there is still NO REASON for this to kill her.

I once took care of a man who had a pair of SCISSORS stuck through his eye (he came to the ER with the scissors still impaled through the eye socket.

Now, he wound up losing eyesight in that eye, but he never even lost consciousness.

It is understandable for people to think that getting shot in the eye = death, but this is NOT the case. That's the mystery here. How did she die? Why did she die?

I will be updating this story soon, so be sure to check back...

CodeBlueBlogMD

[Rä]

The ball never entered her eyes, its what blunt force trauma that caused massive intracranial hemorrhaging.

Here is an image of her, notably hers are bleeding from the impact, but the ball did not "exploded in her eye". This is just stupid.

http://www.ogrish.com/archives/2004/october/OGRISH-dot-com-2-45848.jpg

[CodeBlueBlogMD]

Mr. Rah:

What is your expertise? It doesn't seem to be the English language because I can't actually decipher the gibberish you wrote.

I have 20 years experience and the medical equivalent of 2 PhD's and I studied this case, did the research, and made my conclusions.

What did YOU do, drink a Coke and burp up that comment?

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