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

5/8/2014 History and initial hospital course • 9/3/2011: 25 year contestant on The Biggest Loser. Inman Abbott Case Presentation • Fall from appx 40-50 feet. • Brought into the ER GCS of 3. The Biggest Loser - edition Intubated in ER for airway protection. • CT scan obtained showing large subdural hematoma with shift. Taken emergently for decompressive Patrick Horst hemicraniectomy and hematoma May 8, 2014 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 1

5/8/2014 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? 2

5/8/2014 9/9/11 – post op films • 9/9/11: ORIF pubic symphysis and SI screw placement. Remained stable, intubated, and transferred back to the ICU. 9/12/11 – • 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. How much did the patient weigh? 3

5/8/2014 9/12/11 – 9/20/11 9/9/11 (comparison) Plan? 9/21/11 post op imaging • 9/21/11: Revision of posterior pelvic fixation with modified triangular osteosynthesis and pedicle screw placement S1. • Post-operatively, readmitted to ICU, remained intubated. 4

5/8/2014 • 9/22/11: extubated • 4/1/2012 (7 months post-op) – he was married to women he was engaged to before • NWB BLE, recovered well and began working the accident. with PT • July 11, 2012 their first child was born. • 9/24/11: Transferred to CPMC. 5