New Delhi: On November 25th, Vijay, 24, sustained multiple injuries of the brain, heart, spine, and hip in an accident. He was rushed to HCMCT Manipal Hospitals, Dwarka in a very serious condition. This severe and life-threatening polytrauma case presented a big challenge for surgeons and doctors from various specialties of the hospital.
With a multi-specialty approach, a team of surgeons and critical care experts swung into action and his life was saved. He underwent multiple surgeries for heart, neck, and hip-bone fractures. The patient has been discharged from the hospital recently and is well mobilized now.
On admission, initial investigations revealed that conscious but disoriented Vijay had polytrauma with a visible brain, chest injury, some external facial injuries, and right lower limb injuries. The cervical spine was immediately immobilized. CT aortography confirmed surgeons’ suspicion of traumatic aortic injury. Given his critical condition, he was planned for urgent Endovascular stent grafting for the aortic tear.
“The open surgery in such cases of polytrauma carries a very high risk of mortality and morbidity as the patient has to be put on a heart-lung machine, risk of bleeding is there, there are chances of spinal cord injury leading to paraplegia, lower limb weakness, and stroke. Hence, we preferred an Endovascular stent grafting which was successfully placed across the tear covering the tear in its full extent,” said Dr. YK Mishra, Chief Cardio-Vascular Surgeon & Head of Cardiac Sciences, HCMCT Manipal Hospitals.
The patient was successfully shifted to ICU with stable hemodynamics and had subsequent spinal fixation by a neurosurgical team and right lower limb fracture fixation by an orthopedics team.
Dr. Anurag Saxena, Head of Neurosurgery, HCMCT Manipal Hospitals explained, “Our first task was to make him stable as his blood pressure was going down and he was suffering from dizziness. Bleeding in the brain, arota rupture, neck, and hip-bone fracture made his condition very unstable. Immediate intervention of the Cardiac and Neuro team was required. There was an imminent threat of the patient being paralyzed from neck below due to his spine injuries.”
“Vijay’s neurological status was also complicated because of head injury. Once the patient got stabilized by the cardiac team, we proceeded for cervical spine surgery. With spinal fixation, we overcome the threat of paralysis. At this age of 24, paralysis could have been a long-term disability. We successfully managed his brain and spine injuries,” added Dr. Saxena who led the team of neurosurgeons.
Finally, the patient underwent surgery to repair his non-spinal injuries (fractures in the hip bone) on December 16. “We pay serious attention to these injuries for multiple purposes, including both the potential of future function as well as for general nursing and physician or critical care,” said Dr. Lalit Kumar Lohia, Consultant – Orthopaedics, HCMCT Manipal Hospitals.
The patient responded well and being young he overcame polytrauma in the quickest possible time due to timely interventions of a multi-specialty team of experienced surgeons.
Expressing gratitude towards surgeons and the Hospital, Vijay said, “Even though my condition was very critical but I was conscious and had tremendous faith in highly experienced surgeons at Manipal Hospitals. Once they managed my heart and brain injuries, I got my confidence back that I would be fully cured here.”
The successful management of this polytrauma case highlights the importance of prompt diagnosis and management of critical cases and also underlines the importance of a multidisciplinary team approach.