August 2000
What Happened to Jennifer
    One thing every parent knows: Accidents can happen to kids. One thing every parent needs to know: what services hospitals have to care for kids. It pays to know about the special pediatric facilities available at Bridgeport Hospital.

When the crashing and spinning and the shriek of tires stopped, Robin Katz was so disoriented she didn't quite realize what had happened. Then she heard moans, and she hazily realized—an accident...three or four cars swerving and banging into each other and flying through the air...and oh, God, the kids—Jennifer and Corey were seatbelted in the back of the minivan!

In pain from a broken rib and a broken finger, Robin's first thought was to get her kids out of the van in case there was a fire. Nine-year-old Corey's face was bruised and ten-year-old Jennifer was complaining that her stomach hurt, but initially it seemed Robin had borne the brunt of the damage in her vehicle. A look around showed her that people in other cars were more seriously injured. One car was piled on top of another; the intersection was strewn with broken glass.

Rescue and EMS crews quickly arrived. An American Medical Response (AMR) ambulance took two patients, whose car had gone airborne, to the Level I (highest level) Trauma Center at Bridgeport Hospital. Another ambulance took the Katzes to the closest hospital. At that moment, it didn't seem to matter, since the Katz children didn't appear to be badly injured. But what happened to Jennifer in that accident was worse than it looked. Much worse.


As a member of Bridgeport Hospital's Trauma Team, physician assistant Paul Possenti, clinical coordinator of Trauma/Surgical Critical Care, knows what a car crash can do to the human body. In fact, he was in Bridgeport Hospital's Trauma Center, helping to treat the other patients from the accident, when he first heard about Jennifer Katz. Word came in that the physicians treating Jennifer had made the decision to transfer her to Bridgeport Hospital, where pediatric specialists are available.

Paul had a high index of suspicion about anyone involved in this accident. A high index of suspicion is when an expert takes a look at a situation and suspects that there's more than meets the eye. Paul knew the victims he had already seen were severely injured. So when he heard what happened to Jennifer, he said, "Why don't I just go over there and ride back with her in the paramedic ambulance?"

When he got there, Robin Katz was having X-rays taken. Paul went straight to Jennifer. A look at the CAT scan (like an X-ray of soft tissues) showed fluid in her abdomen-but did not make it clear what the fluid was. Blood? Bile? Her skin was gray, and she was hunched over, guarding her stomach, where the lightest touch caused pain. Paul's index of suspicion was mounting by the minute.

Robin Katz says, "When I came out of X-ray in my hospital gown, Paul was with Jennifer. He told me she had internal injuries and needed to go to Bridgeport Hospital immediately. In fact, he barely waited for me to change into my street clothes before we were in the ambulance. We had to leave Corey behind; my sister and brother-in-law stayed with him. I felt like I was being torn in two." Robin was just beginning to appreciate the special services for children available at Bridgeport Hospital.


Greater Bridgeport's Most Complete Pediatric Services
In the Greater Bridgeport area, only Bridgeport Hospital has a Pediatric Intensive Care Unit (ICU), hospital-based pediatric critical care specialists on staff, and all of the special equipment and expertise children need and deserve. In the seven months between October 1, 1999, and April 30, 2000, more than 95% of the children admitted in the Greater Bridgeport area came to Bridgeport Hospital.

Lights whirling and sirens blaring, the ambulance rushed Jennifer through Bridgeport. On the way, Paul took her blood pressure. "Go faster," he quietly told the driver.

In Bridgeport Hospital's Emergency Department, trauma surgeon Michael Ivy's index of suspicion shot off the top of the scale. Jennifer's blood pressure had dropped briefly; her heartbeat was too fast, and quick ultrasound tests confirmed fluid in her abdomen. Without further delay, Dr. Ivy took her up to the operating room (OR). He wanted to see what was going on inside Jennifer's abdomen. So did chief of Trauma and Surgical Critical Care Nabil Atweh, MD, who also put on surgical scrubs and went to the OR.

What they found was worse than they expected. When the impact threw Jennifer against her seat belt, her common bile duct had been completely torn away from the pancreas. This is a rare—and life-threatening—injury, because the common bile duct is critical for digesting food.

To try to reattach the severed, damaged duct to the pancreas would be like trying to sew a noodle to a scoop of mashed potatoes, says Dr. Ivy. It can't be done. So instead, in a very unusual, four-hour procedure, he and his team used a part of Jennifer's small intestine to create a new common bile duct.


Rare Injury; Rare Procedure
"Afterwards, we did a search of the literature on bile duct injuries, and found that, world-wide, only 15 of these procedures have ever been done on children," says Paul Possenti, who was part of Jennifer's surgical team. "And several of those children died. That's how rare this procedure is."

If Jennifer's injury was rare, so was the speed of her diagnosis. On average, a severed bile duct is not diagnosed until 18 days after the accident. Thanks to the training and extensive experience of Bridgeport Hospital's trauma team, Jennifer's injury was diagnosed within hours.

When the bile duct had been recreated, Dr. Ivy's team placed a temporary feeding tube through Jennifer's side into her intestine so nutrition could be provided directly to the intestine during her recovery. Then they placed another tube to drain fluids from Jennifer's pancreas, bruised in the accident.

Meanwhile, Robin Katz was in the OR Waiting Room, forgetting her broken finger and ribs in her concern over Jennifer. But before she could learn how things were going in the operating room, trauma program coordinator Mike Pineau, RN, came to take her back down to the Emergency Department: Corey had also been transferred to Bridgeport Hospital with vomiting and fluid in his belly. After being assessed in the ED, he went to the Pediatric Center, and Robin went with him to pace the floor and wait for word about Jennifer. That was when Robin Katz first met the nurses who would become her constant companions and supporters, and Jennifer's caretakers, for the next two months. (Fortunately, Corey's injuries were less severe than Jennifer's; he went home within a few days.)


Seat Belts Do Save Lives!
Jennifer Katz knows that her seatbelt contributed to her injury.
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