Management of a road traffic accident victim with severe head injury, and aspiration: A case report

Prathap.M1, Subina.I2, Sivagami. C3*

1ICU Senior Staff Nurse, Kauvery hospital, Salem

2ICU Senior Staff Nurse, Kauvery hospital, Salem

3ANS, Department of Nursing, Kauvery hospital, Salem

*Correspondence: M: 9578970004; Email ID: [email protected]

Case presentation

A 75 years old male patient was received in ER on 31/12/23 at 1. 10pm with a history of RTA with nasal bleed. He initially was taken to outside hospital and later referred here for further management.

Past medical History

Known, case of DM / IHD / CAD – post PTCA on antiplatelet and statin.

On Examination

On receiving, he was drowsy, irritable.

BP was 70/40mmHg, inj. Nor adrenaline started.

At 3 pm patient had decreased sensorium – in view of aspiration into the lungs and poor GCS (E2 V2 M5). Patient was intubated.

Investigations

  • CT brain showed- Left tempo parietal SDH.
  • CT chest showed – Diffuse pulmonary congestion minimal sub pleural atelectasis.

Management

Patient was shifted to ICU with ventilator support. Cardiac opinion obtained – Normal LV. He was at risk of further deterioration hence emergency craniotomy was suggested and this was clearly explained to the patient attenders through video counselling. They were willing for the further management. Patient was reviewed by Diabetologist and pulmonologist.

On 2nd day (31/12/23): CT brain showed no changes. GCS E1M4VT on ventilator. Patient was changed to CPAP mode with 40% FIO2. On 3rd day plan tracheostomy for early weaning off ventilator and adequate chest toileting. Patient was having fever (99°F). Tracheostomy procedure explained to patient attenders and they were willing. At 3pm procedure done. After tracheostomy, patient was on ventilator and CPAP mode 30% FIO2. Again patient was having persistent fever.

On 5th day: Blood c/s showed – No growth. Tracheal secretion grew – Klebsiella pneumonia with, Acinetobactor growth. As per the culture, antibiotics were escalated to Colistin.

On 8th Day: His temperature decreased. He was on T. Piece with 3 liter O2.Then O2 was on tapered to 1 liter

On 9th Day: patient improved and obeyed simple comments. He was shifted to step down ICU to prevent infection. GCS improved E4M6VT on TPS.

On 10th Day: Patient had no fever and responded to commands. Proper nursing care was given, 2nd hourly position change, back care, suctioning, bath, mobilization and musical therapy were given to the patient. No pressure sore was evident.

On 13th Day: GCS E4 MF VT .Patient was not having fever; half closure done, he remained well on half closure.

On 16th Day: He was symptomatically better, with no fever. Secretion decreased.

On 20th Day: We Planned discharge with half closure. Later patient was reviewed on OPD. Through post discharge call, we enquired the patient condition to the attenders, and patient was fine.

On 03.02.24: He was admitted for Decannulation procedure.

On 05.02.24: Decannulation done. Tolerated oral feeds. Ambulated with support.

On 11.02.24: He was discharged.

Nursing Care: – Proper nursing care was given, 2nd hourly position, back care, suctioning, bath, and mobilization, musical therapy were given to the patient. No pressure sore was evident.

Condition at Discharge

  1. Patient conscious and obeying simple commands.
  2. Symptomatically better
  3. No fresh deficits
  4. Wound health
  5. On Ryle’s tube / On Foley’s catheter.

 

Prathap. M
ICU Senior Staff nurse

Subina. I
ICU Senior Staff nurse

Sivagami. C
ANS, Department of Nursing

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