KOTA KINABALU: Medical officials who initially attended to Zara Qairina Mahathir when she was brought to Queen Elizabeth Hospital on July 16 did not notice any signs of abuse on her body, the Coroner's Court was told.
Dr Janefer Voo, a 32-year-old medical officer with the hospital, said she was the first to attend to the case at 4.38am, followed by other members of the emergency unit.
She said there were noticeable injuries on the back of Zara’s head, including swelling and bleeding, an open fracture on her left ankle and a closed fracture on the right ankle.
She added that she did not notice any "barcode" (self-harm) injuries.
Dr Voo said a trauma alert was activated at 4.42am, followed by resuscitation procedures.
The third witness in the Zara Qairina inquest said she suspected severe traumatic brain injury, apart from injuries on the back of the patient’s head, broken bones and possible internal injuries.
In her witness statement, she mentioned that internal injuries may have been caused by a high impact, compounded by the patient's severe low blood pressure.
She said further inspection found no signs of bruises or abuse on the body, only injuries to the back of her head, broken bones in her left hand and both ankles, as well as her left heel.
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Injuries were detected on her skull later, after an imaging procedure, she added.
Dr Voo said medical officials at the hospital did everything they could according to trauma protocols to resuscitate and stabilise the 13-year-old.
She also told the court that Zara Qairina was unconscious when she arrived at the emergency and trauma unit.
When examined by the coordinating officer, deputy prosecuting chief Datuk Badiuszaman Ahmad, she explained that after the trauma alert was activated, the attending team – comprising herself, specialists and medical officials from various units – assessed the patient's injuries and condition.
They administered medication according to the injuries and requirements, sent samples for laboratory tests, conducted CT scans, radiology imaging and provided further treatment for the injuries and trauma, Dr Voo added.
She said Zara Qairina's detailed injuries included bleeding in her brain, the ankle fractures mentioned earlier, lumbar fractures, as well as blood clots in her hip and left psoas muscle, which connects the spine to the leg.
Laboratory results came back abnormal, with a medium to low level of potassium, possibly because of physiological reaction to the trauma; and a high acid level, possibly from injured tissues, she added.
X-rays showed a closed fracture at the end of the left radius in her forearm; a closed fracture of the right tibia and ankle; an open fracture of the left tibia, ankle and heel; three lumbar bone fractures; as well as a compression fracture, Dr Voo said.
A CT scan of the brain and cervical spine showed bleeding in the brain, causing swelling; hypoxic-ischemic injury or brain damage from a lack of blood circulation in the brain; but no broken neck bones or skull, she added.
During resuscitation or trauma life support protocol, she explained that among the procedures conducted were to insert breathing tubes, using a cervical collar to protect her neck or back of her head, bandages and stitches on open wounds to control bleeding and fixed splints on broken or fractured areas.
For medication, a total of 10 different medicines were administered, the court heard.
These include IV fentanyl and IV rocuronium, which is premedication before intubation, anti-tetanus shots for wounds, IV tranexamic acid to control bleeding and patient trauma, IV cefuroxime and IV flagyl as antibiotics to prevent infection, IV potassium chloride to treat low potassium level, IVI fentanyl and IVI midazolam as anaesthesics (for sedation) and IVI noradrenaline to help stabilise blood pressure.
Dr Voo stressed multiple times on the severity of Zara’s condition when she first arrived at the hospital, and told the court that the main focus at that point of time was to save her life instead of prioritising other procedures such as lodging police reports or keeping tabs on what happened to Zara’s clothes.
She said Zara’s clothes had to be removed for a full thorough physical examination but was not sure what happened to the clothes or who kept it or packed it up.
She told the court that she did not notice whether there were bruises on her neck due to the cervical collar, nor barcode injuries as splints were already put on her wrist and arm due to the fracture, and that there were no "red scratch marks" on the back of Zara’s body.
The inquest continues at 2pm.
