A Patients Survival Story
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![Page 1: A Patients Survival Story](https://reader034.fdocuments.us/reader034/viewer/2022051516/56813320550346895d99f281/html5/thumbnails/1.jpg)
A Patients Survival Story
Dr Laura Attwood
EM Consultant, RVIPre Hospital Care Consultant, GNAAS
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Aim
• Case Review
• Services/Personnel Involved
• A Patients Perspective
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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
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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
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On arrival
• Police on scene
• St John’s Ambulance with patient (2 tech crew)
• Rapid Response Paramedic
• Road closures in both directions
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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
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Decision Making Process
• Protect Airway with RSI• Right chest Thoracostomy• Pelvic Binder• Bilateral Wrist Splints• Large IV access• TXA• 1500mls fluid
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On the move
• Left scene 12:31• Landed at RVI 12:41• MHP requested• Chest drain requested
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In ED
• Primary Survey• Bilateral Chest drains inserted• Remained Haemodynamically unstable• MHP: 7RBC, 4 FFP, 1 Platelets, 1 Cryo• CT scan
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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
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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
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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
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A Patients Perspective