Description of Event or Problem · 1
THE DIRECTOR OF CLINICAL RESEARCH REPORTED IN 2004 THAT A PT PRESENTED TO THE HOSP STATUS POST FALL. THE PT WAS IN THE THROWS OF A COUGHING FIT (BEING TREATED FOR BRONCHITIS AND KNOWN TO HAVE THESE COUGHING FITS, VIGAL AND PASS OUT) PASSED OUT AND FELL STRAIGHT BACK HITTING THEIR HEAD ON THE CONCRETE. GLASGOW COMA SCALE WAS 4-6 IN THE FIELD, THE PT WAS TRANSPORTED TO OUTSIDE HOSP WHERE PT WAS INTUBATED (WITH DIFFICULTY) AND THEN TRANSPORTED TO THIS FACILITY. PT WAS ADMITTED TO NEURO INTENSIVE CARE UNIT. A CT SCAN WAS CONDUCTED, WHICH REVEALED DIFFUSE SUBARCHNOID HEMMORRHAGE, RIGHT FRONTAL CONTUSION, SMALL RIGHT SUBDURAL HEMATOMA, DIFFUSE EDEMA PATTERN NEARLY OBLITERATING BASAL CISTERNS. THE PT WAS PREPARED FOR A NEURO-ANGIOGRAM. NO EVIDENCE OF ANEURYSMAL BLEED WAS PRESENT. THE PT WAS TREATED AS A TRAUMA. UPON RETURN TO THE NEURO INTENSIVE CARE UNIT THE LICOX DEVICE WAS PLACED AT 4:30PM; WITH GLASGOW COMA SCALE WAS 3. NO DIFFICULTY WAS ENCOUNTERED PASSING ANY CATHETER. THE OXYGEN CATHETER (PROBE) WAS PLACED FIRST, FOLLOWED BY THE TEMPERATURE CATHETER (PROBE) AND THEN THE INTRACRANIAL PRESSURE MONITORING CATHETER (110-4L). THE 110-4L CATHETER WAS PLACED AT THE RIGHT FRONTAL (AREA OF CT PATHOLOGY). THE CATHETER WAS ZEROED PRIOR TO INSERTION. AFTER INSERTION OF THE 110-4L CATHETER NO WAVEFORM, NO NUMBER, AND NO PRESSURE LINE WAS DISPLAYED. TWO DIFFERENT MONITORS WERE USED TO REGISTER THE ICP READING WITH NO CHANGE. A NEW 110-4L WAS OPENED TO REPLACE THE INITIAL 110-4L THAT WAS NOT FUNCTIONING. ADD'L INFO WAS REC'D IN 2004. THE SECOND 110-4L WAS PLACED THROUGH THE SAME LICOX BOLT AS THE FIRST. THE CATHETER WAS ZEROED PRIOR TO INSERTION. WAVEFORM WAS INITIALLY VISUALIZED WITH PRESSURE READING OF 33. THEN UPON CLOSURE OF THE COMPRESSION CAP THE WAVE FORM WAS LOST WITH A PRESSURE READING OF 86 AT 4:55PM THAT DECELERATED TO 46 AT 6:34PM OVER 30 MINUTES. THE GLASGOW COMA SCALE WAS 1. 1 AND 5 DURING THAT TIME PERIOD, STRAIGHT LINE WAS DISPLAYED WITH NO WAVEFORM. OXYGEN READING WAS 8.6 ON 50% OF FRACTION OF INSPIRED OXYGEN. OXYGEN CHALLENGE WAS CONDUCTED; TWO MINUTES AT 100% WITH AN OXYGEN READING INCREASE TO 16.2. BRAIN TEMPERATURE WAS 38.4. THE NEUROSURGEON PLACED A 110-4HM NEXT TO THE LICOX BOLT ON THE RIGHT SIDE OF THE PATIENT'S CRANIUM. AT THIS THE PATIENT WAS RECEIVING BOLUS SEDATION AND MOVING SPONTANEOUSLY ON THE RIGHT BUT WEAK ON THE LEFT. AT 6:45PM THE 110-4HM BOLT WAS PLACED WITHOUT DIFFICULTY WITH A + + WAVEFORM OF 44. THE 110-41. WAS READING 48. THE PATIENT WAS TAKEN TO OPERATING ROOM FOR HEMICRANIECTOMY AT 7:15PM. A SECOND LICOX WAS PLACED POST OPERATIVELY ON THE LEFT SIDE OF THE PATIENTS CRANIUM AT 1AM 20 THE 110-4L CATHETER USED WITH THIS LICOX DEVICE WAS WORKING PROPERLY. UPON INSERTION THE INTRACRANIAL PRESSURE READING WAS 16. THE OXYGEN READING WAS 54.2 AND THE BRAIN TEMPERATURE READING WAS 38.6 ON 50% FRACTIONAL OF INSPIRED OXYGEN AT 3AM WHEN RECORDING OF READINGS BEGAN (AFTER BRAIN TISSUE SETTLEMENT). THE PT RE-BLED AND WAS REMOVED FROM LIFE SUPPORT AT THE FAMILIES REQUEST. SHORTLY AFTER THE PT EXPIRED. ADD'L INFO WAS REC'D TEN DAYS LATER FROM INTEGRA CLINICAL EDUCATOR; THE PT PRESENTED WITH INCREASE TINTRACRANIAL PRESSURE FROM THE INITIATION OF ICP MONITORING. ONE DAY POST TRAUMA THE ICP READING WAS UP TO 50 WITH NO WAVE FORM PRESENT. THE PT WAS TAKEN FOR A CT SCAN WHICH INDICATED THE PT WOULD PRESENT WITH INCREASE INTRACRANIAL PRESSURE DUE TO THEIR CLINICAL FINDINGS ON THE CT SCAN. THEREFORE THE ICP READING FROM THE 110-4L WAS CORRECT EXCEPT THE WAVEFORM WAS NO LONGER PRESENT. A PARENCHAMAL CATHETER 110-4B WAS PLACED NEAR THE 110-4L, GIVING THE SAME MEASURE OF ICP AS THE 110-4L. THE POSSIBLE CAUSE OF THE LOST WAVEFORM ON THE 110-4L MAY BE DUE TO THE BRAIN SWELLING CAUSING THE BRAIN TO SWELL INTO THE BELLOWS AND THE 110-4L PLACEMENT COULD NOT BE ADJUSTED; RESULTING IN NO WAVEFORM. THE ICP PRESSURE RESULTING FROM THE 110-4L WAS ACCURATE FOR THIS PT'S CONDITION. THIS INFO WAS DISCUSSED WITH THE USER FACILITY DIRECTOR OF CLINICAL RESEARCH.