Case Study 11: Melbourne to Wollongong

Royal Melbourne Hospital to Wollongong Hospital NSW

On June 21, 2011 a 32-year-old male fell down a flight of nine stairs.  He was found to have a Glasgow Coma Scale (GCS) 7/15 at the scene of the incident and was taken to Royal Melbourne Hospital, where his GCS decreased to 3/15. A Computed Tomography (CT) brain scan revealed a large left Sub-Dural Haematoma (SDH), left frontal parietal contusion and midline shift of 2cm. There was no base of skull fracture and was taken to theatre for a left frontal craniotomy, evacuation of the SDH and insertion of an Inter Cranial Pressure (ICP) monitor.

His previous medical history includes childhood meningitis, epilepsy diagnoses at age 22, right temporal lobectomy at St Vincent in 2010 and was waiting for placement in an alcohol detox program.

During this event he remained in intensive care unit for 14 days due to spikes in ICP when sedation was weaned off, increased seizure activity from previous epilepsy, and developing a bowel and chest infection resulting in two failed extubations.

A tracheotomy was inserted on July 4, he was transferred to the neurosurgical high dependency unit for ongoing treatment respiratory management and rehabilitation. Over the next 10 days he continued to clinically improve allowing a trial cuff down of his tracheotomy and the use of a speaking valve. Despite clinical improvements his neurology remained dense with a left hemiplegia.

Medical Connect clinically assessed the patient on June 13 for two hours. An oxygen and seating challenge was performed and with no family in Melbourne a decision was made to repatriate him back to his family in Wollongong.

A rehabilitation bed at Wollongong Hospital NSW was made available and he was repatriated on July 19, 2011 before moving into the Brain Injury Unit.

At twelve months post repatriation the client has gained good functionality and is independent with social support.