Written by:
Dr Declan Brady, Trauma Registrar, Royal Adelaide Hospital
Dr Martie Botha, Trauma Consultant, Royal Adelaide Hospital
Assoc. Prof. Daniel Ellis, Director of Trauma, Royal Adelaide Hospital
The Case:
An 85 year old male who lives at home independently, had a fall while out walking his dog, striking his forehead on the ground without loss of consciousness. Paramedics brought him to hospital where he was diagnosed with a comminuted C1 fracture and type 2 odontoid peg fracture. He had no neurological signs or symptoms. He was admitted to hospital for conservative management of this unstable fracture. While in hospital he was managed in spinal precautions, which involved minimal mobilisation and predominantly kept supine. After remaining well on the ward for 48 hours, he was found to have stridor, hoarse voice, CO2 narcosis, and saturations of 60% on room air which appeared to be airway obstruction. In view of his overall condition and the longer-term consequences of his injury, aggressive escalation of care was not deemed appropriate. The patient was kept comfortable and died a short time later.
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