Abukalam Nour, Kannan Sudha Resshme, Al Marzooqi Muneer
Emergency Medicine, Tawam Hospital, Al Ain, ARE.
Cureus. 2023 Dec 21;15(12):e50898. doi: 10.7759/cureus.50898. eCollection 2023 Dec.
A 51-year-old male patient was brought to the emergency department (ED) by paramedics after an unwitnessed fall from a height while he was working. He sustained a severe head injury with a low Glasgow Coma Scale (GCS). After securing his airway and stabilizing the patient, a CT scan of the brain was done that revealed bilateral subdural hematomas, and an electrocardiogram (EKG) revealed an ST elevation inferior wall myocardial infarction (MI), which was suggested to be the cause of his fall. With the presence of two concomitant life-threatening medical conditions, it was a predicament which of the two pathologies to target first in treatment. Ultimately, a management plan was decided following a multidisciplinary urgent meeting in the ED, which was attended by all respective teams. Initial conservative management with close neurological and cardiovascular monitoring in the intensive care unit (ICU) was deemed the safest option in this case.
一名51岁男性患者在工作时从高处坠落，旁人未目睹，随后被护理人员送往急诊科（ED）。他因严重头部受伤，格拉斯哥昏迷量表（GCS）评分较低。在确保气道通畅并使患者病情稳定后，进行了脑部CT扫描，结果显示双侧硬膜下血肿，心电图（EKG）显示下壁ST段抬高型心肌梗死（MI），提示这可能是他坠落的原因。由于存在两种危及生命的合并症，治疗时首先针对哪种病症成为了一个难题。最终，在急诊科召开了多学科紧急会议，各相关团队均有参加，随后制定了一个管理计划。在这种情况下，最初在重症监护病房（ICU）进行保守治疗并密切进行神经和心血管监测被认为是最安全的选择。
