Upload
xylia
View
42
Download
0
Embed Size (px)
DESCRIPTION
2007-7-17 外傷科 Intern 趙家宏. Trauma Case Conference. Patient Profile. 馬王○雪, 28y/o , Female Date of ER visiting : 2007-07-09 Mechanism of Injury :計程車副駕駛乘客,卡在椅子和手套之間 Sent to our ER at 05:44 AM by EMT. Condition at Scene. Vital sign: BP 105/59, T/P/R:36.9/111/10 AVPU : Unrespondsive, - PowerPoint PPT Presentation
Citation preview
2007-7-17外傷科 Intern 趙家宏
Trauma Case Conference
Patient Profile 馬王○雪, 28y/o , Female Date of ER visiting : 2007-07-09 Mechanism of Injury :計程車副駕駛乘客,卡
在椅子和手套之間 Sent to our ER at 05:44 AM by EMT
Condition at Scene Vital sign: BP 105/59, T/P/R:36.9/111/10 AVPU : Unrespondsive, GCS scale: E 1V1M5, Consciousness:
coma On neck collar
Resuscitation Start resuscitation on 5:44 AM
On E-T tube Fr-7.5, fixed 22 cm IVF: L/R 1000 cc, N/S:1000cc On Monitor On neck collar
Primary Survey and Management
Airway On oral endotracheal tube Assume a cervical spine injury and on neck collar
Breathing Artificial ventilation Decompression and drainage of tension
pneumothorax/haemothorax
Primary Survey and Management
Circulation with haemorrhage control Stop external haemorrhage Establish 2 large-bore IV lines (14 or 16 G) if
possible with administer fluids Disability
A V P U: unresponsive Exposure
Left knee laceration wound 5-6 cm
Primary Survey and Management
Lab CBC, DC, CRP GOT,GTP, Bun, Cr, Na, K PT,PTT Troponin-I, CPK, CK-MB
X-ray CXR Pelvic
CT Brain
Wound CD and suture laceration wound with nylon 4-0
2007/7/9 6:00 AM
2007/07/09 6:00 Brain CT
Brain CT finding
Traumatic subarachnoid hemorrhage with rupture into ventricles.
Suspect subdural hemorrhage along the anterior falx.
Right pneumothorax with left hemothorax On endotracheal tube. No imaging evidence of C-spine fracture.
Lab
Secondary Survey and Management
Airway On oral endotracheal tube On neck collar
Breathing R’t pneumothorax and left hemothorax Artificial ventilation On chest tube (6:25 AM)
Secondary Survey and Management
Circulation with haemorrhage control PRBC 2u at 9:00AM
Disability and Differential Diagnosis SAH and SDH consult NS Elevated liver enzyme: liver laceration is
suspected Arrange abdominal CT Exposure
Left knee laceration wound with suture line
Chest X-ray 7:30chest tube 太深,外拉 2cm
Abdomen CT <8:00 AM>
Abdominal CT finding
Liver laceration injury of S8 of r’t hepatic lobe , with hemoperitoneum, AAST:Gr III-IV, cannot rule out active bleeding
Hemopericardium Bil hemothorax
Impression
Traumatic SAH and IVH R’t pneumothorax left hemothorax Liver laceration Gr III-IV Hemopericardium r/o cardiac temponade
Resuscitation 10:00 AM
Give hyperventilation, FiO2 set 30% 輸血 PRBC 2U(9:00), 備血 PRBC 6U
10:20 AM BP 86/45 PR 120/min Keep blood transfusion PE: BS, bil present, coarse over l’t side, mild
decrease over r’t side, Abdomen: soft Consult HBS surgeon Consult CVS
HBS surgery 7/9
1. Dx:Liver laceration
2. Laparotomy+hepatorrhaphy+choleycystostomy+ packing of liver
7/13
1. Liver packing gauze remove
CVS surgery
7/9r/o hemopericardium , Ant mediestinum hematoma
1. Explore pericardiotomy <No hemopericardium, ,inimal pericardial effusion>
2. Fr 28 chest inserted to the substernal space 7/10 r/oAnt mediestinum hematoma,
manubrium fracture1. Sternum ORIF, check bleeding