1 / 14

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

zephr-richard
Télécharger la présentation

A Patients Survival Story

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related