Misdiagnosed fracture of Th-7 vertebrae in intensive care unit.

We report the case an 18-year-old girl admitted in intensive care unit (ICU) in severe clinical condition after a car crash. She arrived at ICU around 04.50 in the morning and was conscious, with abnormally fast respiratory rate, low blood pressure, and tachycardia. After the supine radiograph of the chest, right hemathopneumothorax was evident and thoracic drainage was performed. After four hours, during morning physical examination, the coming intensivist discovered the loss of motor and sensible sensations in the lower and upper extremities. The patient became quadriplegic. In emergent radiograph of vertebral column, the fracture of thoracic 7th vertebra, and complete dislocation of spinal cord at the level Th 7-Th 8, was revealed. Patient died the same day before the arrival in operating room. The detail imaging of vertebral column and immobilization of patient failed. On the early morning, the intensivist was very exhausted and low concentration was evident. After the consequences of this specific case, the hours of duty in intensive care unit in our country were reduced from 24 work hours to 12 work hours. The question remains... Is it possible that the exhaustion and the inadequate organization are enough reasons to cause a young girl's death?