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From Death We Learn 2009

From Death We Learn 2009. Intoxicated Head Injury in a Regional Hospital Office of Safety and Quality in Healthcare Reference: Kidner Inquest July 2008. The Case. Background A man in his 40s presented to a regional hospital Emergency Department

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From Death We Learn 2009

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  1. From Death We Learn 2009 Intoxicated Head Injury in a Regional Hospital Office of Safety and Quality in Healthcare Reference: Kidner Inquest July 2008

  2. The Case Background • A man in his 40s presented to a regional hospital Emergency Department • Following a series of closed head injuries over the previous 36 hours • Intoxicated with alcohol • On one occasion he fell from a bar stool after which he was observed to be bleeding from the ear.

  3. The Case Management • In hospital he was intoxicated and aggressive, and could not be managed with available resources. • He was advised to stay for observation but he refused • Head injury advice sheets were provided and he was discharged accompanied by a friend.

  4. The Case Outcome • The man and his friend returned to a social event where he displayed erratic behaviour then fell asleep on a trampoline in full view of the party. • The following morning he was unrousable, then later found deceased. • Post mortem examination revealed: • a fractured base of skull • significant alcohol intoxication • fatal head injuries.

  5. The Inquest Deputy State Coroner noted: • Deceased had a very high tolerance to alcohol & was known for his erratic behaviour. • Deceased had a series of alcohol related closed head injuries within the 36 hours prior to presentation. • Death rose by way of accident BUT THAT…

  6. The Inquest • Deputy State Coroner noted: • Hospital care, although understandable, was not optimal: • There were indications for: • admission & observation • urgent CT scanning • This was not possible because: • Deceased’s behaviour could not be controlled • Patient did not remain in the hospital for observation • Hospital conditions did not allow the provision of proper medical care. • There was no capacity at the hospital to restrain or sedate him • The hospital had no CT scanner

  7. The Inquest The Deputy State Coroner made the following recommendations: (after benchmarking against towns of similar size) • The hospital should be funded for a CT scan service. • The hospital should be adequately funded to provide appropriate care to patients in the developing region where it is situated. • The issue of inadequate security for staff and patients be addressed immediately. • Head Injury criteria sheets are posted in the Emergency Department so they are obvious to patients as well as staff in stressful circumstances.

  8. Key messages • The management of patients with head injuries who are intoxicated is challenging. • A period of observation and an assessment of competence should guide decisions about discharge. • Physical restraint and sedation may be needed to manage patients appropriately. • Reasonable access to early CT scanning is the standard for all patients with significant head injury. • Guidelines for the management of head injured patients and the indications for CT scanning are available.

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