Recently, a young man was transferred to our trauma center from St. Albans after sustaining injuries in a truck crash. The initial report from the Emergency Department physician included injuries to the ribs and a “Grade V liver injury.” This type of injury to the liver is the worst and typically, it is not survivable. I suggested that they transfer the patient immediately, and we would activate the trauma team. Quite frankly, we were thinking that the patient was not going to survive the transport to our facility.
Based on what we knew, we decided to bypass the Emergency Department and take the patient straight to the Operating Room (OR) for laparotomy and liver packing as soon as he arrived. I walked up to the OR and everyone in charge at the front desk was accommodating and enthusiastically set about getting a room ready. Anesthesia was notified, the massive transfusion policy was activated, blood salvage was set up, and the entire OR team worked together to anticipate the arrival of this critically ill patient.
When the patient was brought in to the OR, he looked awful, pale as a ghost, incoherent, tachycardic and hypotensive. As if a starting gun had fired, all teams in the OR started working together to get the patient on the table, insert lines, intubate, transfuse, prepare equipment (do the counts) and anesthetize. The room was relatively quiet and the efficiency of the work effort was amazing. After a few minutes, the laparotomy could begin in a much more stable patient.
With the expert help of Antonio DiCarlo, we were able to control the massive bleeding by removing about one-third of the destroyed liver to gain access to the bleeding points. The liver had to be packed and the patient was successfully brought back to the OR a few days later for pack removal and closure.
A mere five days later, this patient was sitting up in bed, talking to us, and asking for a drink of water. Imagine that . . . this patient had what is commonly thought of as a fatal injury, and because of the “working together as one” attitude of all who took care of him, we saw him eventually discharged home with his family. What a success story for our trauma center!
John B. Fortune, MD, FACS is a trauma and critical care surgeon at the UVM Medical Center. He is also a Professor of Surgery at the Larner College of Medicine at UVM.