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Thursday, December 17, 2015

Racing Against Time

Posted By: Advancing Care

Faced with a potentially fatal construction-site accident, the trauma team at MidHudson Regional Hospital worked quickly to save a life.



A mysterious puncture wound. A language barrier. A nail piercing the heart. A life on the line.

This stranger-than-fiction scenario unfolded in less than an hour last summer at MidHudson Regional Hospital, a member of the Westchester Medical Center Health Network.

“I saw a gentleman hurrying a young man through our sliding glass doors. He was clearly in urgent need of care,” said Carole Hilbrandt, RN, in the Emergency Department at MidHudson Regional Hospital. “Upon initial assessment we found a small puncture wound on the left side of his chest. I remember thinking to myself, Was this guy shot?”

Radiologists quickly located the problem — a foreign object burrowed into the man’s heart. Imaging studies also showed that fluid — most likely blood — was surrounding the heart. To relieve pressure on the heart, doctors quickly performed a pericardiocentesis: using a needle to withdraw fluid from the sac between the heart and the chest.

With help from hospital interpreters, physicians and nurses began piecing together the mysterious circumstances that brought this young man to the Emergency Department. He had been helping his uncle at a construction site when a nail fired from a nail gun pierced the board he was holding, penetrating his sternum. Faced with a dire situation, his uncle raced him to the Trauma Center at MidHudson Regional Hospital.

Now the trauma staff faced a number of split-second decisions.  They had the capability to open his chest in the Emergency Department but felt it was better to get him to the fully equipped, high-tech environs of the operating rooms. “I alerted the OR team (including Zubair Zoha, MD, Associate Chief of Trauma Surgery) that our patient was headed right upstairs,” says Carly Herr, RN.

When the surgical team opened the patient’s chest, Dr. Zoha visually confirmed the nail had indeed lodged itself in his heart, and he was continuing to lose blood. The team knew they needed to remove the object and close the wound without delay. Along with Surgical Technician Todd Alston, the team was able to remove the nail. Dr. Zoha placed his finger into the hole to stop the hemorrhaging.

But the trauma team faced yet another significant challenge: “Before I could put the stitches over the opening, before I could repair it, the patient’s heart stopped. He was going into cardiac arrest,” says Dr. Zoha. With his finger still plugging the hole, he reached into the young man’s chest with his other hand and began massaging the heart manually.

“We needed to stimulate circulation to keep the heart pumping and keep the blood flowing to the brain,” Dr. Zoha says.

This maneuver resulted in the patient’s heart restarting, giving the trauma surgeon the time and stabilization necessary to close the wound to the heart. The surgery was a success, and nine days later, the patient was released.

Reflecting back on the case, Dr. Zoha praises all members of MidHudson’s trauma team — Operating Room, Emergency Department, surgeons, cardiologists, intensive care, and the blood bank — with coming together to do what they do best, save a life.

“That day was a prime example of everyone working as one with a single goal in mind,” Dr. Zoha says. “The patient went from going into cardiac arrest on the operating table to a full recovery.”

Trauma Care at WMCHealth:

WMCHealth is home to Level I and Level II trauma centers, caring for our area’s most ill and injured patients.

Level I Trauma Centers:

Westchester Medical Center

Maria Fareri Children’s Hospital

Level II Trauma Centers:

MidHudson Regional Hospital

Good Samaritan Hospital