Trauma/Critical Care M&M Kevin Caldwell

Background 60yo F presents to MMC ED after fall from standing with -LOC and GCS of 15 *Found to have broken ribs and SDH measuring 12mm seen on CT Head and Neurosurgery consulted *Patient begins to rapidly deteriorate needing intubation and repeat CT showing increase in size with right to left shift *Trauma Team consulted and patient unresponsive on examination

Background -PMH of Metastatic Breast Cancer -Fell due to dizziness while returning home from receiving chemotherapy at Cancer Center of America for Metastatic Breast Cancer

Hospital Course -Taken soon after arrival for emergent craniotomy and evacuation of SDH with drain placement by NS and placed on 3% NS -Remained intubated in ICU with minimal responsiveness -MRI Brain completed on POD#2 with 1cm right to left shift -Neurosurgery discusses poor prognosis and recommends withdraw of care on POD#5 -Made DNR POD#7 -Patient made comfort care and passed away POD#8

Situation Diagnosis: Subdural Hematoma Complication: Death Attending: Wall/Reid Resident: Caldwell, Trauma Team Grade: IV Classification: Patient Disease What could have been done differently: call Trauma Team earlier though likely would not have changed outcome

Recommendations -Retrospective review -Leukemia and prostate cancer most SDHs -Coagulopathy and trauma, most common etiology, often together -SDH compares favorably to other IH, 43% vs 22%; independent 67% to 48%

Questions?