By Jerry Bernard, M.D., Hôpital Sacré Coeur Surgeon
On the night of September 8, 2014, we received a severely injured patient who came to the ER of Hôpital Sacré Coeur, one hour after the injury occurred. The 40 year old patient had multiple knife stab wounds in the face, the scalp, the right shoulder and in the left forearm. He was also agitated and had a bad neurologic status.
The critical lacerations were those on the face and on the L superior limb. The wound on the face was bad, deep and very hemorrhagic. It went from the left check to the left occipital side. The ear cartilage was transected, the facial nerve was cut and the capsula on the top of the mandibular joint was torn and the joint was open. The wound on the left forearm had muscular, nerve and tendons damages.
The first Hg was around 5, 2g of Hb and we needed to get the patient to the operating room as fast as possible.
The first procedure was hemostatic: we tried to clamp and ligate the great bleeders. Then, because it was still bleeding and hosing a lot; we packed the laceration site and sutured the skin on top of it. At the same time, the orthopedic physician was repairing the damages on
After transfusing 3 units of blood (because after the first procedure Hb dropped to 4,9g), we came back to the operating room, completing hemostasis and adding the plastic surgery touch by repairing and approximating the different structures involved in the laceration. Unfortunately, we could not do much for the facial nerve, but at least the patient looked many times better than we he came in to the ED.
The patient was discharged in good shape three weeks later, especially because he was under orthopedics and emergency department surveillance.