Upload
daniel-jordan
View
221
Download
2
Tags:
Embed Size (px)
Citation preview
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
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