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MULTIDISCIPLINARY MEDICAL TEAM MEETING RE: DET. DAVID MICHAEL STARSKY, June 22, 1979

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THE POST GUNTHER SESSIONS

 

MULTIDISCIPLINARY MEDICAL TEAM MEETING
RE: DET. DAVID MICHAEL STARSKY,


June 22, 1979 – 5:35 PM, Memorial

Jacqueline©2019-09-25

 

HISTORY:
Patient:                   David Michael Starsky, white male, age 32
Date of admission: May 15, 1979 - 1:50 PM; time of incident: approx. 1:08 PM
Category:                Multi-trauma and Injury; Penetrating injuries to trunk: 3 gunshot wounds (GSW); suspected trauma to spinal cord; severe
                               (internal) bleeding/suspected arterial haemorrhage; weak / irregular pulse; respiratory distress; unconscious.
ER:                          trauma staff worked to stabilize the patient until finally at 2:45 PM he could be transferred to the OR for surgery.
OR:                         Trauma surgery team (OTT 4) – 9 hrs, 17 minutes; 3 bullets removed; 10 pints of blood; cardiac arrest after 4 hrs and
                               12 minutes; thoracotomy; resuscitation 7 minutes; cont. surgery.

Post-op status:      critical; comatose;
May 16, 1979 03:21 PM: cardiac arrest  resuscitation 14 minutes.
May 17, 1979 08.30 PM: Downgraded to serious/guarded
May 18, 1979 09:20 AM: off ventilator; nasal canula – status coma unchanged until 08:05 AM: patient conscious
May 19, 1979 07:56 AM: patient awake – cognitive ability could not be tested yet
May 20, 1979 11:05 AM: level 1 cognitive ability test; failed
May 21, 1979 08:45 AM: level 1 cognitive ability test: successful
May 22, 1979 10:15 AM: cognitive skills: adequate (non verbal);  short term memory: unsatisfactory
May 23, 1979 09:45 AM: level 2 cognitive ability test: failed; respiratory infection
May 24, 1979 08:15 AM: respiratory infection; intravenous antibiotics; decision pending on putting patient on ventilator again.
May 25, 1979 08.15 AM: restless night; fever spiking at 104 degrees; upgrade intravenous antibiotics; patient sedated
May 26, 1979 08.15 AM: situation unchanged
May 27, 1979 08.15 AM: slight improvement; fever down to 100 degrees
May 28, 1979 08.15 AM: patient’s temperature down to normal level; sedation level reduced
May 29, 1979 09:15 AM: patient off sedation, temperature normal, first psychological assessment cancelled
May 30, 1979 10:05 AM: situation unchanged; introduction gelatin; special attention swallowing
May 31, 1979 09:30 AM: note nursing staff regarding development of bedsores; special attention/treatment plan
June 01, 1979 10:30 AM  wound care pressure ulcer started
June 02, 1979 08:15 AM  patient transferred to high care unit; special matress, wound care cont’d.
June 03, 1979 05:30 PM  introduction applesauce; nausea (admin. Prochlorperazine)
June 04, 1979 08:30 AM  breakfast gelatin first success after swallowing training; spontaneous breathing trial (STB) started to wean patient off
                                       cannula – 20% reduction oxygen level after 30 minute trial; SB moments will be increased by 10 minutes each day with
                                       2 hour breaks; monitoring (Sarge/Kramer alternating)
June 05, 1979 12:30 PM  pressure ulcer responding well to treatment; patient cognitive test level 3 successful; oatmeal/gelatin lunch, soft fruit:
                                       tolerated.
June 06, 1979 09:30 AM patient’s bed raised 15 degrees; monitoring Colley/Aaronson subsequent consultation Jamison (head of trauma 1,
                                       critical care, physiatrist)/Aaronson (physical therapist) re therapy plan;
June 07, 1979 10:15 AM Pulmonary testing postponed in light of after effects of injury and surgery; STB continued: additional 15% reduction
                                       oxygen level (time intervals unchanged, Colley/Frantz alternating) pressure ulcer 80% healed; yoghurt: tolerated
June 08, 1979 10:05 AM Muscle strength/ROM testing (Aaronson, passive – assisted - mobilization protocol / muscle stretching protocol started);
                                       soft food / mash food diet started 3x/day; patient ready for first psychological assesment (Jamison / Johanson)
June 09,1979 08:30 AM  patient’s bed raised additional 15 degrees; monitoring Colley/ Aaronson subsequent consultation P(a)MP;
June 10, 1979 10:05 AM Pulmonary testing successful (level 2), STB longer interfalls, oxygen reduction unchanged; P(a)MP
June 11, 1979 11:15 AM First psychologocal assessment (Johanson – advice for follow-up Jamison/Aaronson); additional 20% reduction oxygen
                                       level (time intervals unchanged, Sarge/Kramer alternating), patient’s bed raised additional 15 degrees (monitoring
                                       Colley)
June 12, 1979 08:30 PM  Patient white blood count elevated: bladder infection, oral  anti-biotics started; 103 degrees; can’t keep food down;
                                       special attention; switch to intravenous antibiotics for night
June 13, 1979 10:15 AM  Patient temperature unchanged; gelatin tolerated; extra fluids cont’d; 24 hr alert
June 14, 1979 09:15 AM  Patient’s temperature normal; white blood count normal; mash food re-started (optional Prochlorperazine)
June 15, 1979 02:30 PM  Last day intravenous antibiotics; breakfast: mashed bananas on ½ toast – tolerated; P(a)MP/ROM & muscle stretching
                                       cont’d.
June 16, 1979  03:45 PM Patient’s bed elevation 90 degrees total; exercise regimen expanded – standing up (20 sec each time – 5 min intervals);
                                       strengthening exercises extremities expanded; pulmonary testing level 4 successful
June 17, 1979 07:50 PM  Patient spent majority of day in (semi-)seated position; all read-outs (BP/HR/O2sat) normal; breakfast: toast+mashed
                                       banana, yoghurt; lunch: broth/toast; dinner: mash (potato/chicken/ Apple sauce)
June 18, 1979 02:20 PM  P(a)MP/ROM & muscle stretching/ standing up (30 sec each time – 5 min intervals), strengthening exercises extremities
                                       cont’d.
June 19, 1979 08:50 PM  Patient transfer to wheelchair practiced; time in wheelchair 5 min.,  readouts elevated; returned to normal after 4 min.
                                       43 sec.; motor  development test: negative; consultation Aaronson/Foretti/Jamison exercise plan
June 20, 1979 09:20 AM Wheelchair transfer + seat. time in wheelchair 5 min., readouts elevated; returned to normal after 4 min. 02 sec.;
                                       P(a)MP/ROM & muscle stretching/ standing up (45 sec each time – 5 min intervals), strengthening exercises extremities
                                      cont’d.
June 21, 1979 04:50 PM PT exercises expanded; readouts: cont’d improvement; pulmonary test level 5 successful


Status updates:
Cavanaugh (pulmonologist):
Patient is on level 5 on the pulmonary test schedule. His progress this week is astounding. Lungs sound clearer, coordination between breathing and swallowing has improved to near normal level. Therapy can be concluded.

Foretti (neurologist):
I agree with dr Cavenaugh that patient’s progress this week has been truly remarkable. His fine motor skills (hand-eye coordination) are still lagging behind. Reflexes near normal. The therapy developed with Aaronson (PT) neuro-/physical is clearly the right method for this patient. Cognitive skills normal – still slightly impaired when fatigued.

Aaronson (physical therapist):
I’m taken by surprise by this week’s surge in patient’s progress. He is very motivated and determined to get back on his feet as soon as possible. Keeping in mind dr Johanson’s earlier admonition regarding the danger of his desire to recover, I had to moderate him from time to time. Still, I do feel that a regular schedule for PT can start after the weekend.

Johanson (psychologist):
I’ve had two brief consultations with patient, together with dr Aaronson. I stand by my remark from our last team meeting that we should be cautious to be caught on the waves of patient’s optimism. We should remain professional and temper him. I feel we are still in unknown territory as far as a successful recovery from injuries as extensive and serious as Mr Starsky’s were and still are. In my opinion his – somewhat ingenuous – character is connected to the early loss of his father and is also the reason for, what I mentioned in our last meeting, the reason for his not wanting to burden especially his mother, but also his immediate circle. I want to urge our team to take note of that.

Jamison (head of trauma 1, critical care, physiatrist):
So noted. First I would like to thank you all present here and the rest of the team for your committment to this patient. I think I can speak for all of us that this remarkable young man has put us in touch again with the reason why we entered the world of medicine --- of caring and healing, in the first place --- just a bit where it may have dulled or settled a bit over the course of our time here, in Memorial, or in other care facilities. Det. Starsky is indeed a special case. I agree with dr Johanson as I think we all do, that his enthousiasm is very contagious. But we want the best for him and to hurry is not in his best interest. However, within the next few days we have to prepare him for a transfer to a rehabilitation facility to continue his recovery. We have all probed patient about his ideas for the rest of his recovery and he has told all of us that he does not want to go to a regular facility. He seems to think he will be well enough to walk out of this hospital and go straight home. I think that may pose a problem; although his progress is remarkable, I think it is unrealistic to think he may skip a stay at a rehab facility all together. I’ve set a meeting for Monday with the entire team and the expertise team of the Bay City Physical Rehabilitation Center to discuss his case after they have evaluated him in a session.

Conclusion:
Jamison (head of trauma 1, critical care, physiatrist):
Patient’s overall improvement is picking up steam. Prognoses for transfer to rehab center; further physical and psychological assessment in coming week. Meeting with and evaluation by expertise team of BCPRC Monday.