Case Records of the Massachusetts General Hospital. Case 36-2012. Recovery of a 16-Year-Old Girl from Trauma and Burns After a Car Accident

• Main Authors: Sheridan, Robert L, Schaefer, Pamela W, Whalen, Michael, Fagan, Shawn, Stoddard, Jr, Frederick J, Schneider, Jeffrey C, McConkey, Brock, Cancio, Leopoldo C
• Format: Report
• Language: English
• Subjects: ACCIDENTS; AMPUTATION; BURNS(INJURIES); CAR ACCIDENTS; CASE STUDIES; INHALATION INJURIES; Medicine and Medical Research; MULTIPLE TRAUMA; PROSTHETICS; PSYCHIATRY; REHABILITATION; SKIN GRAFTS; TRAUMA; TRAUMATIC BRAIN INJURIES

A 16-year-old girl was admitted to this hospital because of trauma and extensive burns sustained in a motor-vehicle accident. The patient had been well until the day of admission when, while driving alone and restrained with a seat belt, her vehicle collided at high speed with a tree and burst into flames. She reportedly had blunt head trauma and was trapped in the burning vehicle with windows closed for approximately 10 minutes, until extricated by passersby who shattered a window. She reportedly was initially awake and in severe pain. Emergency medical service responders sedated and intubated her at the scene because of extensive burns to the face and concern for airway patency. She was immobilized with a cervical collar and a backboard and was transported by medical helicopter to this hospital. The patient had a history of hypothyroidism, for which she took levothyroxine daily. She had no known allergies. She was a high-school student, lived with her parents and a sibling, and was a highly competitive athlete. On examination in the emergency department, the patient was unconscious, sedated, and paralyzed, and the trachea was intubated. The temperature was 35.6 C, the blood pressure 156/101 mm Hg, the pulse 108 beats per minute, and the oxygen saturation 100% while high-flow oxygen was being delivered. The pupils were 2 mm in diameter and minimally reactive bilaterally. There were intermittent, slight spontaneous movements of both arms and the left leg. There were burns on the face, vibrissae, eyebrows, eyelashes, hair, and scalp. Full-thickness burns involved approximately 70% of the skin surface, including most of the torso and distal limbs, which were tense on examination. The legs had sustained distal soft-tissue avulsion with extensive soft-tissue loss. Spared areas included the left upper chest and the posterior-medial portion of the left leg and thigh. Published in the New England Journal of Medicine, v367 n21 p2027-2037, 22 Nov 2012.