CAYMAN ISLANDS TRAUMA TEAM SAVES IMPALED CAR ACCIDENT VICTIM

Injured man walks out of the hospital just one week after a fence pole went through his chest

Not many people can say they saw a pole go through their chest and lived to tell the tale. Nicholas Connor, age 30, was gravely injured when the car he was driving ran into a chain link fence, thrusting a steel pole through his body. A call to 911 from a chance passerby, and the subsequent response by emergency services personnel and world-class surgeons at Health City Cayman Islands saved his lifeon that early morning.

With every second vital for his survival due to the severe trauma and blood loss, and with the pole still in his chest and protruding through his back, Connor was freed from his vehicle by the fire brigade then taken for initial assessment at the Cayman Islands Health Services Authority’s (HSA) George Town hospital.

With his injuries deemed immediately life-threatening by the Emergency Room doctors at the HSA, Connor was then rushed to Health City, the Cayman Islands’ sole local tertiary care facility. As a super-specialty tertiary care hospital and trauma center, Health City had a multi-disciplinary team of surgeons assembled in minutes to await the patient’s arrival.

Dr. Binoy Chattuparambil, Health City’s Clinical Director and Chief Cardiac Surgeon, got the early morning call: “I was at home sleeping. At 2:30am I got a call from the government hospital that there was an urgent case. Somebody got into an accident and an iron pipe had gone through the chest - through and through.”

Dr. Chattuparambil described Connor’s condition upon arriving at the hospital’s new 24-hour Level 3 Trauma Center: “He was lying on one side with a very big iron pipe through the chest and coming out of his back and he could not lie down. He was awake and it was very scary for him and his parents, who were there with his brother.”

Connor’s injury was so serious and unusual that despite many years of collective experience, this was the first time the surgical team at Health City had seen such a complicated case.

“I realized we didn’t havemuch time to waste. Immediately, we had to do a CT scan - at least to know what structures were pierced while the pipe had gone through. The problem was, this pipe was projecting [out of his body] on both sides. He will not go through the CT scan,” Dr. Chattuparambil described.

In order to assess the injuries Dr. Chattuparambil had to request the help of the fire brigade to trim the pole still stuck in Connor’s chest so he could fit inside the Computerized Tomography (CT) scan machine.

Sedated, Connor was wheeled outside so the Cayman Islands Fire Services’ specialized equipment could be used to cut more of the pole away from his body. He was then whisked back inside for the scan, which revealed that the pole had not damaged any of the major blood vessels. However, it had badly damaged his lung and around six or seven ribs were broken in multiple places. His right elbow was also completely shattered.

Immediately after the scan was done Health City’s surgical team jumped into action.

The anesthesia team, led by Medical Director, Senior Consultant and Cardiac Anesthesiologist Dr. Dhruva Krishnan, intubated the patient while he was lying on his side and isolated the injured right lung with a double lumen endotracheal tube.

Dr. Krishnan recognized the urgency: “We were racing against time. He was stable but his oxygen levels could have dropped any time and this injury could have gotten worse. And, there were tubes and lines we had to place when he was in that very precarious position. A special tube called w-mint was used to ventilate the left lung so the injured right lung could be deflated to enable surgical repair.”

While the main priority was extracting the pipe from the patient’s chest, Dr. Chattuparambil called in orthopedic surgeons - Dr. NiranjanNagaraja and Dr. Ravi Kiran - to treat the shattered ribs.

A long and complicated procedure repaired the lung and the ribs, enabling Connor to eventually breathe without mechanical assistance.

Dr. Krishnan praised the efficiency of the multidisciplinary surgical team and the remarkable efforts of the nurses and physiotherapists who worked overtime to keep Connor alive and stable.

“We needed at least 10 people to mobilize him from the triage to the CT Scan room and to the CT Scan gantry very delicately,” he said.

Being able to see and analyse the injuries caused by the pole was key to successful treatment.

Dr. SharathBabu, Consultant Radiologist, said the radiology specialists at Health City were skilled professionals backed by “tremendously experienced technicians who could get the best images making it easier for the surgeons to operate.”

The care provided was so efficient that Connor spent only two days in the Intensive Care Unit before being discharged from the hospital just a week later.Amazingly, he was able to walk out of the hospital on his own.

After his incredible recovery, Connor recalled the outcome of that dreadful day: “The surgeons did a very good job repairing seven ribs that were broken and my lung that was punctured. They told me that I am a lucky man and I give thanks to God. It could have been worse.”

Dr. Chattuparambil was delighted by the excellent outcome considering the degree of difficulty and complexity of the case.

“I was really happy that we have a very good team to treat this kind of complex case, because these are the cases nobody will have experienced. [In fact] I’m seeing this for the first time. But as a tertiary care trauma center, our multi-specialty team is available 24/7 to treat this kind of patient.It is a very satisfying case, as it was very difficult and went very well. I am very glad,” he said.

As for Connor, this dramatic episode was his first experience at Health City Cayman Islands and he says he will remain grateful to the team there for saving his life.

“They encourage you and they show you how lucky you are, and how good God is to you. That’s why you’re still alive. And you know, they are very nice people. I love them,” he said.