Monthly Archives: December 2011

BMC Saves Patient Impaled by Nail Gun

Patrick Matheson was working on a new house on Nantucket Dec. 1, nailing plywood on the second floor, when he made what he calls a “rookie mistake.”

X-ray

 

An X-ray of the nail in Matheson

“I was holding the gun at an angle when I shot it and the nail bounced off the wood,” says the 31-year-old carpenter. “I felt the nail hit me but there was no blood. I couldn’t see it and I could breathe and talk. I slowly climbed down the ladder, alerted my coworkers and then walked out to the end of the road to wait for the ambulance to arrive.”

What Matheson didn’t know was the three-and-a-half-inch nail had entered the base of his neck and plunged directly into his chest.

Matheson was rushed to Nantucket Cottage Hospital and then quickly transported by MedFlight helicopter to Boston Medical Center. He arrived in the Emergency Department (ED) where he says staff made sure he was very comfortable, before meeting the man who would be his surgeon, Michael Ebright, MD, Cardiothoracic Surgery.

Ebright’s first task was to determine the extent of the injury. The nail, which had been traveling at 1,400 feet per second when it entered Matheson’s chest, had pierced his trachea and esophagus before lodging in his vertebral column.

“My chief concern was whether the nail had injured any of the large arteries branching directly from the aorta above the heart,” says Ebright.

Ebright obtained an arteriogram that revealed the nail had miraculously, and narrowly, missed the large arteries sitting within the trajectory of the nail. In fact, a large artery supplying the brain and right arm actually was nudged over to the side, yet remained intact.

In surgery, Ebright discovered just how close to death Matheson had come. Had the nail entered his chest just a millimeter to the right, it would have severed this major artery and he would likely have bled to death at the construction site. And had the nail been just one inch longer, it would have pierced his spinal cord, possibly leaving him a paraplegic.

Patrick Matheson 
Patrick Matheson

Ebright also discovered something else: the nail lodged in Matheson had barbs coming off the shaft, making its removal past the artery it was nestled against that much trickier.

“We operated through an incision at the base of the neck and were able to tease the major artery off the nail,” says Ebright. “We wanted to make sure the barb didn’t catch the artery, so we put a gauze buffer between the nail and the artery. There was no major bleeding, no problems, and we repaired the trachea and esophagus.

“Patrick is very lucky to be alive and walking,” he adds.

Following his two-hour surgery, Matheson recuperated on 8 East Newton Pavilion for a week. He says his whole experience at BMC has been terrific.

“Everyone has been amazing,” he says. “Nurses have been checking on me even when they have a lot going on. Dr. Ebright has stopped by every day. The level of care and professional, from top to bottom, has been terrific. It’s really lifted my spirits.”

He looks forward to going home and spending time with his girlfriend and baby. And he plans to take a few weeks off from the construction business.

 

BMC operates the longest, continuously verified Level 1 Trauma Center in New England. Read some of its patient success stories.

 

A Tragic Event and the Long Road to Recovery

Daniel Rioux was walking back to his office after a workout out like he had so many times before when a 20,000 pound scaffolding platform at a Boston construction site came crashing fifteen stories down. Three people including two construction workers and a local physician also passing by died that April afternoon, but Daniel survived. “I was struck in the lower right leg by a large piece of metal,” says Rioux. “It shattered my bone and it was sticking out. A dead body lay a few feet away from me. I was the sole survivor of the incident and am lucky to be here today.”

When Rioux realized the severity of his injuries, he began screaming for help. “I assumed that I was going to lose part of my leg and actually visualized myself with a prosthetic,” says Rioux. He was rushed to Boston Medical Center, fortunate to be alive but with substantial leg injuries. His right tibia and fibula – the lower leg bones – were fractured and open, meaning the bone had pushed out through the skin.

Upon arrival to BMC’s Trauma Center, Rioux met Paul Tornetta, MD, FACS, FAOOS, Professor and Vice Chairman, Department of Orthopaedic Surgery, Boston University School of Medicine and the Director of Orthopaedic Trauma for Boston Medical Center. Dr. Tornetta laid out many options for Rioux including: amputation;  bone transport, a technique where bone tissue is regenerated within a patients extremity; bone graft, where bone is taken from the patient’s own healthy bone (autograft) or from frozen, donated bone (allograft); or having a permanently shorter leg.

“Mr. Rioux had a severe open tibia fracture,” say Tornetta. “While there are many options for treatment, the primary initial goal is to decrease the risk of infection by performing a thorough cleaning of the bone surfaces, stabilizing the bone, and then obtaining coverage over the bone with healthy soft tissues.”

After weighing the various options, they decided to create a treatment plan to save Rioux’s leg. “We use the term ‘limb salvage’ to describe the decision and process to save the leg rather than do an early amputation,” says Tornetta. “Many times difficult decisions need to be made and our job is to provide information to the patient and help them make choices about their treatment plan which makes the most sense for them.”

“I was very happy with the care I received from Dr. Tornetta,” says Rioux. “There were painful and difficult decisions that had to be made, but he and his team were very helpful in clearly laying out the options and providing information and about each one.”

Rioux’s road to recovery has been long and arduous; including an initial month long hospital stay, as well as numerous one to two week planned and staged admissions for complex repairs. In all, Rioux had 12 surgical procedures, including application of an external fixator, where pins are inserted through the skin into the bone and held in place by an external frame allowing proper alignment of the bones.

This procedure is commonly used for severe open fractures and allows for management of soft tissue injuries and for easier access into the affected area for cleaning. In fact, despite the best treatment options, the infection rate for such severe injuries is still in the range of 20 percent and that is why some surgeons recommend early amputation.

Following the initial internal fixator procedure, Rioux needed revisions of the external fixation to adjust alignment, a pivot of his soleus muscle, where the calf muscle is shifted around the tibia bone and a skin graft, a procedure where skin from his thigh was transferred to cover the portion of skin where the bone had come through his leg.

“Several recent studies demonstrate that nearly 100 percent of patients will have significant deficits after such injuries,” says Tornetta. “Our goal is always to support the patients’ return to as close to normal function as possible”.

Today Rioux is back to working out three times a week and even coaches his son’s Little League baseball team where he is on the field and pitches to the kids. “I also plan to play golf again,” says Rioux. “I have hit balls at the range and it will be interesting to see how I do on the course!” Also, this past Father’s Day, his wife gave him a new bicycle. Returning back to normal physical shape is also important for Rioux’s work, where travel is essential to maintaining and building business. Most importantly though, Rioux is once again able to keep up with his wife and kids – “I am able to do a lot with them now that I wasn’t able to do for a long while,” he says.

 

Patients share their BMC experience

On behalf of the New England Organ Bank (NEOB), I would like to thank the staff of the 5E-Surgery Intensive Care Unit (SICU) and the Critical Care Team for their support during a recent case that led to the recovery and successful transplantation of the heart, liver and kidneys.

Letter writing 

I have heard from my staff of the profound complexities of this patient and family. I wanted to acknowledge the compassion, support and patience the team provided. Throughout the process the physician and nursing teams were very helpful in our clinical assessment of the patient. The bedside nursing team provided excellent care of the patient while in the midst of very challenging circumstances. The social work and chaplaincy staff were critical in guiding and supporting the family. The staff’s commitment to the donation process helped preserve the option of donation and allowed for a seamless introduction of NEOB staff to the family. Specific recognition should be made of Nurse Judy McGonagle as she was pivotal in facilitating our discussions with the next of kin. The combined efforts of both 5E-SICU and NEOB staff contributed to the outcome of saving the lives of four people.

Once again, we extend a heartfelt thanks to all Boston Medical Center staff involved, for their dedication and collaboration with the New England Organ Bank. The collaboration and support is critical to ensuring a successful donation process at Boston Medical Center and the recovery of life-saving organs.

We truly appreciate everyone’s commitment and hard work.

Sincerely,
Richard Luskin
President and CEO  

Boston Magazine’s Top Docs 2011

Boston_magazine

Boston Magazine’s 2011 “Top Docs” issue is out, and we are happy to announce two members of the Trauma Surgery and Critical Care team have been included. Suresh Agarwal, MD, Chief, Critical Care and Peter Burke, MD, Chief, Trauma Services are being recognized for being “tops” in their respective fields. The care and support they provide to Boston Medical Center patients and their families is exemplary, and we’re proud that they’re receiving such well-deserved recognition.

Peter Burke, MD, Chief of Trauma Surgery and Suresh Agarwal, MD, Chief of Critical Care at Boston Medical Center Publish Chapter in Penetrating Trauma Textbook

Peter Burke, MD, FACS, Chief of Trauma Surgery, Boston Medical Center and Professor of Surgery at Boston University School of Medicine and Suresh Agarwal, MD, FACS, FCCP, Chief of Critical Care at Boston Medical Center and Associate Professor of Surgery at Boston University School of Medicine, published a chapter, “Hypotensive Resuscitation in Penetrating Trauma: Rules of the Game” in the recently published textbook, “Penetrating Trauma“. 

Chapter

 


 

Related News:

 

 

Dr. Burke publishes article in BMC Genomics – Read More

Dr. Agarwal’s awarded grant from the National Trauma Institute for a lung injury research study – Read More.

Dr. Burke and Dr. Agarwal are Boston’s “Top Docs” – Read More.