Case Study 3: Sydney to Auckland

Royal Prince Alfred Hospital Sydney to Auckland Hospital New Zealand

A 78-year-old male admitted with headache, parasthesis to all limbs. A CT-brain scan showed WFNS scale grade-1 and Fisher grade-3 Subarachnoid hematoma. Shortly after he decreased his level of conscious and found to be in Ictus and was transferred to ICU and intubated. CT-brain scan on day 1 showed increased ventriculomegaly and blood loading so a CT-angiography was performed which showed A-comm aneurysm which was secured by coiling.

Two days later his Glasgow Coma Scale (GCS) improved from 9-13/15 as he started obeying commands, however, shortly after dropped his GCS. A further CT-brain scan the next day showed a large blood loading and an external ventricular drain was inserted to relieve this pressure.

While in ICU he developed multiple other medical issues including fast atrial fibrillation, bradycardia with asystolic events of 5-10 seconds requiring the insertion of a pacemaker. Post operatively he had facial seizures, hypernatremia, septic shock from infection. He was eventually transferred to the ward with fluctuating GCS of 10-13/15, however, again dropped to 7/15 and he was returned to ICU.

With occasional fluctuation in his GCS he continue to show improved and was repatriated back to Auckland Hospital New Zealand, for rehabilitation and family support.

At 12 months the patient can walk for 40-45 minutes duration and enjoys light gardening.

“I remember very well the care you took of me when you flew me back to New Zealand. I was particularly impressed that, although you had not been to Auckland before and had a day free to look around, you came to see me in the ward at Auckland Hospital to see how I was getting on after the flight.” Patient