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A Patients Survival Story

A Patients Survival Story. Dr Laura Attwood EM Consultant, RVI Pre 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

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A Patients Survival Story

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  1. A Patients Survival Story Dr Laura Attwood EM Consultant, RVI Pre Hospital Care Consultant, GNAAS

  2. Aim • Case Review • Services/Personnel Involved • A Patients Perspective

  3. 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

  4. 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

  5. On arrival • Police on scene • St John’s Ambulance with patient (2 tech crew) • Rapid Response Paramedic • Road closures in both directions

  6. 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

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

  8. On the move • Left scene 12:31 • Landed at RVI 12:41 • MHP requested • Chest drain requested

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

  10. 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

  11. 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

  12. 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

  13. A Patients Perspective

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