A man in his 40s has Cape Town surgeon, Dr Wimpie Odendaal, to thank for being in the right place at the right time, when he sustained a life-threatening injury in a road accident recently.
Quick-thinking Dr Odendaal, who was first to arrive on the scene, recognised that motorcyclist had sustained a serious chest injury and was able to perform a lifesaving emergency procedure with only rudimentary tools at the roadside while waiting for emergency medical services to arrive.
“My wife, GP, Dr Christa de Wit, and I were on holiday in Port Elizabeth and were driving with my sister-in-law, who is a nursing sister, on a quiet, leafy back road when we happened upon the scene of an accident,” Dr Odendaal, who practises at Netcare Blaauwberg Hospital, recalls.
An injured man was sitting upright in the middle of the road, and a woman, who was clearly very distressed, was standing next to her damaged car. While he was clearly in pain, it was not initially obvious that the man had sustained severe injuries.
“Within seconds, however, the man’s condition deteriorated. He became very short of breath, lost consciousness and no pulse could be felt.”
Dr Odendaal and his wife immediately began performing cardiopulmonary resuscitation (CPR) on the man. “The veins in the patient’s neck were distended and his trachea had shifted. It became evident to me that the man had developed a tension pneumothorax, a life-threatening condition whereby air becomes trapped between the membranes surrounding the lungs inside the ribcage.
“Not only does tension pneumothorax compress the lung, making breathing difficult, if not impossible, it also decreases the flow of blood to the heart and can very quickly lead to cardiopulmonary arrest. I knew that something would need to be done immediately to relieve the tension pneumothorax or the man would have little chance of survival.
“By this time, a few bystanders had gathered at the scene and, as I had no medical equipment in my car except a plastic mouthpiece for mouth to mouth resuscitation, I shouted to ask if anybody had a sharp object I could use. I was offered a pocketknife, and had no other choice than to use this to open the fifth intercostal space anterior to the mid axillary line, which is a specific area between the ribs on the side, to relieve the pressure. If not for this emergency intervention, the man would most likely have died within minutes.”
After a few tense moments on the roadside following Dr Odendaal’s intervention, the tension pneumothorax was relieved and the patient’s condition briefly improved. A basting needle was fetched from a nearby house, which Dr Odendaal used to keep the hole in the patient’s side open. Soon, a Netcare 911 ambulance arrived at the scene and the emergency medical practitioners assisted with resuscitating the man. “We used an endotracheal tube and bowl of water to devise a makeshift under water drain to restore negative pressure to the pleural cavity and prevent the space from re-fi lling with air. A large bore drip needle was used to relieve a second tension pneumothorax,” Dr Odendaal explained.
“The patient was intubated and adrenaline was administered intravenously, and soon he was stable enough that we could transport him to the emergency department at a nearby Netcare hospital.”
According to Dr Odendaal, the man spent several weeks in hospital recuperating from his injuries, which included 14 rib fractures, cardiac and pulmonary contusions, a broken pelvis and a broken foot.“I was really delighted to have a telephone conversation with this gentleman in the last week of January. Since being discharged, he is continuing his recovery at home. I am really grateful that he is alive and well.” Dr Odendaal urges healthcare professionals to always keep a store of basic medical equipment in their vehicles in case of an emergency.
“This incident highlights the potential of healthcare professionals to save lives, but you do need equipment to be able to apply these skills. It is imperative to have basic equipment in your car, which I did not have at the time, but have since acquired,” he says.