Case 1

Patient: 24-year-old woman.

Incident: While riding an MPWC, she lost control and crashed into mangroves. She was thrown from the machine and may have struck her head on the steering column. She was not immersed.

Injuries: Unconscious on arrival at the nearest hospital, with a Glasgow Coma Scale score of 3, left periorbital haematoma, unstable maxilla, and fixed and dilated right pupil. Haemodynamically stable.

Management: Intubation, hyper ventilation and intravenous mannitol. A rigid collar was applied and she was transferred to RNSH. Craniotomy revealed a very high intracranial pressure.

Outcome: She suffered a cardiac arrest and died while under general anaesthesia.

Postmortem: Revealed intracranial haemorrhage, a dislocated C1, a fracture of C3-4 and of C7, and epidural haemorrhage of the cervical spinal cord.