Md. Salim (name changed), a 30-year old man from Burdwan, was unable to breathe when he was rushed into an Emergency Department in a private hospital in Kolkata on August 17. The rapid medical intervention thereafter led to a prompt surgical and therapeutic treatment, playing a pivotal role in the patient’s survival.
Md. Salim, a quiet and happy guy hails from a rural farmer’s family at Bellgram in Burdwan. On 16th August 2018, he, as usual, went to work on the fields and was expected for lunch at home. However, on that fateful day, he did not reach home within the stipulated time. Around 3:00 pm, his family received a phone call from locals saying that he had met with a road traffic accident (RTA) while driving his motorcycle on the way back home and sustained multiple traumatic injuries.
After the initial tests, scans and X-rays at a local hospital, Salim was diagnosed with a dislocated collarbone, injured ribcage, and other external injuries. The condition gradually started worsening since his arrival at the local hospital. Being critically injured, he was referred to Kolkata for consistent shortness of breath which was not relieved in spite of giving oxygen.
When he reported to a private hospital in Kolkata, his shortness of breath was acute and he was unable to lie down. Immediately after admission, the emergency physician’s team thoroughly examined Salim and found that his worsening respiratory distress was somehow not related to multiple rib fractures. Under medical observation, the patient underwent an X-Ray chest as well as a CT scan, which is the basic step of a Trauma Protocol. These revealed a ruptured left side of the diaphragm (the muscular structure which separates the abdomen from the chest), along with the displacement of the stomach to the left side of the chest. It was understood that this caused compression of the heart along with the shifting of the left lung to the right side of the chest, causing gradual respiratory failure and fading blood pressure (BP).
When he reported to a private hospital in Kolkata, his shortness of breath was acute and he was unable to lie down. Immediately after admission, the emergency physician’s team thoroughly examined Salim and found that his worsening respiratory distress was somehow not related to multiple rib fractures. Under medical observation, the patient underwent an X-Ray chest as well as a CT scan, which is the basic step of a Trauma Protocol. These revealed a ruptured left side of the diaphragm (the muscular structure which separates the abdomen from the chest), along with the displacement of the stomach to the left side of the chest. It was understood that this caused compression of the heart along with the shifting of the left lung to the right side of the chest, causing gradual respiratory failure and fading blood pressure (BP).
A medical multi-disciplinary team was formed immediately. Treating doctors decided to perform an emergency laparotomy. The patient was taken to operation theatre (OT) in no time. Laparotomy of the patient revealed that a part of this his stomach had pierced into the chest. Family members comprising Salim’s father, elder sister and a few from neighbourhood were spoken to and duly counselled as the surgery was critical. They understood and gave nod to go ahead. The Cardiothoracic & Vascular Surgery (CTVS) team also joined the treatment since the patient reported with the fracture of the ribs. Within two hours of the evaluation, a multi-disciplinary surgical team was constituted and the patient was wheeled to the operation theatre (OT). The operation took around 5 hours and the surgical team who performed it was happy finally with the outcome.
“We advised urgent explorative laparotomy and immediate chest drain to stabilise him,” said Dr. Barun Nath, Consultant, GI &General Surgery, Medica Superspeciality Hospital.
“The Trauma team plays a crucial role in saving precious lives of many. A skilled emergency team can definitely make a lot of difference in such critical cases. In this case too, where the patient was virtually in between life and death, the emergency team played a life-saving role,” said Dr. Sudeshna Barua, Consultant & HOD, Emergency Department, Medica Superspecialty Hospital.
Salim came to Medica within 12 hours of the accident and got the right treatment. “During the golden hour of survival, if one gets to a hospital quick enough, and gets treated quicker enough, chances of the patient’s survival increase and the patient can be treated well,” said Dr. Sudipta Barua, Associate Consultant, Emergency Department, Medica Superspecialty Hospital.
During the post-operative stage, the patient was shifted to the intensive care unit (ICU) with a ventilator support. He remained stable in his post-operative phase and was weaned off from the ventilator after 3 days of the surgery. Later, he was shifted to the ward and was discharged from the hospital, after a stay of 8-9 days, altogether. “Salim is now recovering at home. He is now doing well and back on his feet. He is feeling great and enjoying the fresh lease of life. We are happy with the treatment at Medica. Salim himself feels much better now and is looking forward to going back to his work,” said Fatima, the elder sister of Salim. In fact, Salim came again to Medica for the post-operative check-up recently and was advised to take rest for a few more days.
“Emergencies can occur at anytime, anywhere and every second counts in such situations. Initial assessment and resuscitation always play a pivotal role in the golden hour treatment. We took up the challenge, and keeping in mind our experts, our team decided to give our best to save Salim,” said Dr. Alok Roy, Chairman, Medica Group of Hospitals.
Medica could save a young promising man because of the teamwork and interplay of multiple departments namely- Emergency, Anaesthesiology, Gastro-surgery, Cardiothoracic surgery, ICU and physiotherapy among others.
- a report by SONGOTI
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