A Patients Survival Story

Dr Laura Attwood

EM Consultant, RVIPre Hospital Care Consultant, GNAAS

Aim

• Case Review

• Services/Personnel Involved

• A Patients Perspective

Background

• Difficult patient to manage in pre-hospital setting

• Multiple traumatic injuries• Prolonged hospital stay• Required transfer from RVI to JCUH as closer

to patients home

Pre Hospital Setting

• Sunday 18th August 2013• Helimed 063 already out on task• Another call for more seriously injured

casualty • Left previous task at 11:31• Arrived on scene 11:46• A696 – Kirkwhelpington

On arrival

• Police on scene

• St John’s Ambulance with patient (2 tech crew)

• Rapid Response Paramedic

• Road closures in both directions

Initial Assessment

• Multiple injuries apparent– Confused patient, multiple facial fractures and

significant bleeding from mouth – Occipital Head Injury– GCS 11/15 (E2, V4, M5)– Right Pneumothorax– Sats 86% on high flow oxygen– Haemodynamically unstable– Probable Pelvic fracture– Bilateral Colles fractures

Decision Making Process

• Protect Airway with RSI• Right chest Thoracostomy• Pelvic Binder• Bilateral Wrist Splints• Large IV access• TXA• 1500mls fluid

On the move

• Left scene 12:31• Landed at RVI 12:41• MHP requested• Chest drain requested

In ED

• Primary Survey• Bilateral Chest drains inserted• Remained Haemodynamically unstable• MHP: 7RBC, 4 FFP, 1 Platelets, 1 Cryo• CT scan

CT – Summary of Injuries

• L Temporal Contusion• Extensive Facial Fractures• Biggest concern – Non functioning R lung– ?bronchus/?pulm artery injury

• L flail chest – ribs 1-5• L2 unstable fracture• Pelvic fracture– Comminuted L hemi pelvis/acetabulum and pubic rami

• Bilateral Wrist fractures

ICU – 19 day stay

• Bronchosocopy – R main bronchus obstruction• Theatre – twice– Both wrists– Rib fixation

• Hospital Acquired Pneumonia • TLSO brace• C Diff positive diarrhoea• Osteomyelitis L wrist ex fix site• Multifactorial Delirium

Orthopaedic Ward – 7 days

• R talar fracture/lat mall fracture identified• Difficulty mobilising requiring hoist• Discussed with JCUH• Transfer arranged– Ongoing mamnagement of orthopaedic problems

and spinal fracture– Closer to Darlington for patient and family

A Patients Perspective