Challenge in acute care surgery: sudden cardiac arrest in the surgical intensive care unit

A patient in their 20s presented to the emergency department after a motor vehicle collision. The patient was noted to be tachycardic, with systolic blood pressure in the 90s. The initial Glasgow Coma Scale (GCS) score was 7 (E1, V2, M4). The patient was intubated for low GCS and transfused two units of packed red blood cells with improved vital signs. Whole-body CT was obtained and found to have subarachnoid hemorrhage and subdural hematoma with multiple facial fractures. CT of the chest and abdomen demonstrated Chance fracture of the thoracic spine at T9–10 level and a small mesenteric hematoma. Additional X-rays noted bilateral radial fractures and right femur fracture. The patient was admitted to the surgical intensive care unit (ICU) for hemodynamic monitoring, serial laboratory evaluation with abdominal examination, and further management of multisystem injuries. After stable head CTs, pharmacologic venous thromboembolism prophylaxis was initiated on hospital day 3. Spinal fusion was performed on hospital day 5, followed by internal fixation of extremity fractures on hospital day 6. On hospital day 7, the patient was taken for MRI of the cervical spine for the evaluation of ligamentous injuries; …