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A Motorcyclist’s Irreparable Injury

aka Trauma Tribulation 008

A 26 year-old male was BIBA after falling off his stationary motorbike at a set of traffic lights. C-spine precautions were removed following palpation of his neck and assessment of his sphincter tone. Initially, his only complaint was pain to his right thumb, presumably from a hyperextension injury. However a detailed secondary survey located a palpable deformity underlying the patient’s left jacket pocket.

Further inspection confirmed your suspicions, this patient sustained an irreversible injury to his third most vital organ:


Questions

Q1. How should this case be managed?

Answer and interpretation

As with any trauma, a team-based approach that targets threats to life, limb or iPhone should be employed. iPhone injuries are best managed in the trauma bay by the most senior clinician available.

  • Assess responsiveness and orientation —
    in this case palpation of the power button failed to elicit even incomprehensible noises and orientation could not be assessed as there was no screen picture.
  • Assess circulation —
    there was inadequate battery reserve to electrically perfuse the iphone’s tissues — this is a state of shock.
  • Obtain expert help early —
    all emergency departments should have their local Apple Genius bar, on speed dial. Unfortunately, in this case, the prognosis given was grave. Expectant care was recommended. Further advice offered was to consider the use of a palliative care pillow, and to start  for a new iPhone
  • Break the bad news —
    This scenario is perhaps the ultimate test of an emergency doctors aequanimitas. With bulging lacrimal glands and a growing globus, you must remain calm while putting the victim out of his misery. Be prepared for a SEPSIS-like syndrome in response. If necessary, use the principle of double effect to ensure that your patient doesn’t suffer needlessly.

Q2. Could this worst case scenario have been avoided?

Answer and interpretation

Yes — as with most cases of severe trauma, prevention is better than the cure.

Although there is no effective cure for acute severe traumatic iPhone failure, there is an elegant means of prevention thanks to an UCEM-approved device. As is self evident from the photo shown below, such a device provides an air of sophistication and style, as well as providing unprecedented protection to the vulnerable tissues of your iPhone.

Yet-to-be published data suggests that it may even endear the user to members of the opposite sex. However, one must remember that this prophylactic only provides protection for your third most important organ… Other forms of protection may also be required.

Of course, another option is to switch to a blackberry…


CLINICAL CASES

Trauma Tribulation

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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