Case Study 12: Melbourne to Brisbane

Royal Melbourne Hospital to Royal Brisbane & Women’s Hospital QLD

On the May 6, 2011, a 67-year-old male from Brisbane was on holidays travelling in Ararat Victoria. Whilst driving he experienced a seizure resulting in a low speed motor vehicle accident. At the scene of the accident he was found to have a Glasgow Coma Scale (GCS) of 4/15 and continued to have the seizure for the next hour. He was taken to Ballarat Base Hospital and on arrival his GCS improved to 14/15. A Computed Tomography (CT) brain revealed a posterior fossa Sub-Arachnoid Haematoma and he was transferred to Royal Melbourne Hospital. On arrival he demonstrated further confusion and was intubated. A further CT brain and Digital Subtraction Angiography showed left and right Mid Cerebral Aneurysm (MCA) with the right one measuring 2 x 2.2 x 3.5cm. As a result he was taken to theatre to have the right MCA clipped.

Recovery post operation was slow with an extended stay of 19 days in the Intensive Care Unit. During this time his medical challenges included reoccurring vasospasm and marked hydrocephalus with a dependence on extra ventricular drainage remaining in-situ. Cardiology events included super ventricular tachycardia, rapid atrial fibrillation and a right internal carotid artery thrombosis. He also developed a ventilator acquired pneumonia contributing in two failed extubations and ultimately a tracheotomy.

On May 25, he was transferred to the Neurosurgical High Dependence Unit Ward for ongoing treatment, airway management and rehabilitation. After three weeks on the ward there was significant clinical improvement and the client could verbalise with a speaking valve, however his neurology remained dense with a left hemiplegia.

On June 16, a rehabilitation bed at Royal Brisbane Hospital was available and within 30 hours from receiving the request Medical Connect repatriated him from Melbourne to Brisbane.