Life can change in an instant. One recent patient was a 25-year-old motorcyclist, riding home in the dark at 40mph. Suddenly, from nowhere, a pedestrian appeared in front of him. He swerved, but the pedestrian tried to dodge him by moving in the same direction. So he hit the pedestrian, and crashed.
An ambulance rushed him to A&E. His main injury was appalling destruction to the back of his left leg. It looked as if a shark had bitten him from behind, just above the knee. Blood oozed out, there was no pulse and no sensation in the foot, and X-rays showed that the femur was broken.
We gave intravenous fluids quickly, to maintain his blood pressure. The concentration of haemoglobin fell rapidly and so, as soon as his blood was cross-matched, he was given a transfusion.
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A motorcyclist comes off worse in a crash with a pedestrian.
dr andrew harrison explains how
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With the circulation to his vital organs now stabilised, he was transferred to the operating theatre. First, the orthopaedic surgeons fixed his femur with a long metal rod down the centre of the bone. Then the vascular surgeons fashioned a new artery to his foot, by using a spare vein. And finally, the plastic surgeons used a skin graft to cover the wound.
Fortunately, he regained feeling in his foot after the operation, so he escaped a discussion about whether it would be better to amputate it. I doubt he will be able to play football again, but at least he will be able to walk.
The pedestrian, by the way, escaped with only a dislocated shoulder and bruises. But he has a guilty conscience, because he knows that he stepped out into the road without looking.
FIRST POSTED MARCH 21, 2007
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