A 25 year old male is admitted to critical care following a motorcycle accident. He hit a car travelling at 60mph, was thrown over the roof and skidded 20m down the road. His injuries include a fractured pelvis, unilateral rib fractures from 6-10 on the left, and a fractured lateral malleolus also on the left.
He underwent surgical fixation of his fractures within 24 hours and is now in critical care. He is receiving nasal high flow oxygen therapy at 40% (60L), no cardiovascular support and a morphine PCAS with a background infusion for his pain.
It is now day 2. His oxygen requirement has begun to increase, alongside an increase in his work of breathing. On examination he has harsh breath sounds across the chest with underlying crepitations on the left side and a pyrexia of 39°C. He has also started to become confused. Within a few hours he develops a hemiplegia with worsening respiratory failure and requires intubation and ventilation. A petechial rash is noted to be developing around his neck and in his axillae.
Written by Dr Sarah Marsh.
First published on 11 November 2019