History and initial hospital course 9/3/2011: 25 year contestant on - - PowerPoint PPT Presentation

5/8/2014 1

Inman Abbott Case Presentation The Biggest Loser - edition

Patrick Horst May 8, 2014

History and initial hospital course

• 9/3/2011: 25 year contestant on The

Biggest Loser.

• Fall from appx 40-50 feet.
• Brought into the ER GCS of 3.

Intubated in ER for airway protection.

• CT scan obtained showing large

subdural hematoma with shift. Taken emergently for decompressive hemicraniectomy and hematoma evacuation.

• Transferred to ICU for stabilization.

Remained hemodynamically stable.

History continued:

• PMH: History of obesity
• Soc: Lives in Hollywood with his fiance, weight loss

instructor.

• Exam:

– Hemodynamically and vital signs stable, no pressors. – Intubated and sedated, non-responsive, not following commands. – ICP monitor, swelling of his left head s/p hemicraniecomy. No stepoffs on his back. – Ext:

• Deformity of pelvis with external rotation of right leg.
• Bilateral thigh and calf abrasions
• Imaging

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History continued

• Distal femoral traction pin placed, patient

remained intubated in ICU. Also found to have distal tibia fracture.

• He remained hemodynamically stable. Hgb

remained stable, but did require transfusion. Fluctuating ICPs and as a result of ICPs, not cleared for surgery. Eventually cleared for surgery on 9/9/2011.

• Surgical plan?

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• 9/9/11: ORIF pubic symphysis and SI screw
• placement. Remained stable, intubated, and

transferred back to the ICU.

9/9/11 – post op films

• Post op course:
• 9/10/11: extubated, initially did well. Moving

all extremities, following commands.

• 9/11/11: increasing O2 requirements and re-

intubated.

• 9/13: Successfully extubated and progressed

with recovery.

9/12/11 – How much did the patient weigh?

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9/12/11 – 9/9/11 (comparison) 9/20/11

Plan?

• 9/21/11: Revision of posterior pelvic fixation

with modified triangular osteosynthesis and pedicle screw placement S1.

• Post-operatively, readmitted to ICU, remained

intubated.

9/21/11 post op imaging

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• 9/22/11: extubated
• NWB BLE, recovered well and began working

with PT

• 9/24/11: Transferred to CPMC.
• 4/1/2012 (7 months post-op) – he was

married to women he was engaged to before the accident.

• July 11, 2012 their first child was born.