Interesting case...

[Eagle5US]

Some VERY interesting cases at work over the past few days....

- Shark bite
- Speargun through the eye AND THE BRAIN (pulled out at a depth of 40ft in salt water) with no residual neural deficit
- Forklift vs human (forklift wins)

And an injury I had never seen before under the circumstance...

*95 y/o male, motor vehicle crash, broken tib/fib and femur on the left.
30 minute transport time, vitals stable, alert and oriented, FAST negative, other signs of trauma, no seat belt sign, chest pain or contusion.

To CT for trauma pan scan-
RESULT
Left hemothorax, 30% all else negative. No rib fractures, no active etravasation (bleeding)

Back to trauma bay....chest tube tray being set up, I am working on admission orders...BP drops to 60/40, HR 140, pt unconscious.

Emergent Chest tube placed, frank blood, 1200 cc immediate out, intubate, ordered massive transfusion protocol and TXA, pressure comes back, called the OR.

10 units PRBC, 4 FFP, 2 platelets, lose pressures again, pleurevac now full (2000cc) and changed out, CPR started, I open his chest thinking an aortic injury gave way post CT scan.

*INSTEAD - the patient had a RUPTURED LEFT VENTRICLE*

The splitwas too large for a foley insertion, Trauma SGN's attempts to clamp the ventricular defect just shredded the pericardium (like trying to clamp a cooked roast) and when I tried throwing stitch into it, everything pulled through and the blood could not be contained.

The patient expired.

While I had seen this IN THE PRESENCE of chest trauma in the past...never had I seen it with isolated long bone injury. The reason FAST was negative on heart view was because when he ruptured the ventricle, he BLEW OUT HIS PERICARDIAL SAC as well so there was no blood collection around the heart.

Incredible learning case.

While I can open a chest I I cannot seem to be smart enough to upload a photo - if anyone can do so, I will send it to you via e-mail.
Thanks...

[ender18d]

Out of curiosity, what caused the crash? Was the patient driving? Makes me wonder if he had acute MI with subsequent wall rupture... have seen plenty of "trauma codes" that were actually medically precipitated.

That said with the pericardium blown out it sounds like it must have been some kind of shear injury from the trauma even in the absence of other signs of chest trauma.

Interesting case!

[Trapper John]

Very interesting cases! But I am curious as to why a shark with a spear from a spear gun in its eye would be brought into your ER? Or did I misinterpret something?

[Eagle5US]

The patient was the driver, ran a red light and was T-boned on the driver’s side (hence the Left sided leg fractures)

There has been much discussion amongst the service and the consensus was that at one time he may have had an ischemic event with “dead heart” along the ventricle where it ruptured and why it wouldn’t hold a stitch or clamp.

Autopsy will tell- would love to post a photo...


As far as the shark with the speargun through his eye with no brain damage ... I’ll take all the practice I can get 😁

[PSM]

Pix:

[Eagle5US]

Thx Buddy👍