From the intensive care bed: we need to hear and listen

Excerpt

Darryl, a 46-year-old businessman, was riding a motorcycle that collided at high speed with a trailer being towed by a utility vehicle. He arrived at our institution, a level I trauma centre, with profound haemodynamic instability and a positive focused abdominal ultrasound scan, and was immediately transferred to the operating theatre. In the operating theatre, he was found to have a right atrial appendage tear requiring urgent repair, bilateral massive retroperitoneal haematomas related to his open book pelvic fracture, which were packed, and a liver contusion with a capsular tear treated conservatively. Darryl also sustained a complex wound communicating directly with his sacrum. Other injuries included extensive rib fractures of his right hemithorax with underlying severe pulmonary contusion and a large right haemothorax. His initial damage control surgery was complemented by damage control resuscitation that included a massive blood transfusion. In the intensive care unit, his APACHE II score was subsequently determined to be 36. So began Darryl’s 35-day intensive care admission. This is Darryl’s story that every intensive care physician must read. …