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Case Report

Case Report. by intern 莊凱峻. Patient profile. Name: 李 X 焜 Gender: male Age: 80 y/o Chart No.:12885542 Date: 96.6.7 pm4:50. Chief complain. Fell down from height (3F  floor) 96.6/7 pm4:22. Present Illness. EMT, on collar Conscious: clear ,E4V5M6

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Case Report

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  1. Case Report by intern 莊凱峻

  2. Patient profile • Name: 李X焜 • Gender: male • Age: 80 y/o • Chart No.:12885542 • Date: 96.6.7 pm4:50

  3. Chief complain • Fell down from height (3Ffloor) 96.6/7 pm4:22

  4. Present Illness • EMT, on collar • Conscious: clear ,E4V5M6 • Pale, cold sweating • TPR: 34.3^, 98/min, 14/min • BP:168/127 mmHg • Neck stiff, Chest pain, Abdomen discomfort

  5. Present Illness • Right face abrasion, ecchymosis • Right elbow open fracture (typeII) • Right forearm abrasion (bleeding) • Left wrist deformity (r/o close fracture) • Right leg deformity (r/o femoral head fracture, pelvis fracture)

  6. Past History • BPH (suspect Prostate CA, PSA>4, but free PSA/total PSA<0.2 ) • HTN (-), DM (-), HBV (-), HCV(-) • Glucose intolerance • Cardiomegaly

  7. Management (16:50) • IV, O2, Monitor (SpO2 86%) • Tetanus Toxoid • Blood examination (CPK:306, Tropo-I:0.21, CK-MB:86.4) • Ice packing • Demeral • Cefazolin +Aq-dest (IV push) • CXR (portable) • Right, left wrist X-ray • Right elbow X-ray • L-spine X-ray

  8. Right femoral X-ray • Pelvis X-ray • Brain+ facial bone CT • L/R 1BT • Wound care, splint use • Check vital sign

  9. (17:34) • BP:118/89 mmHg, pulse:79,conscious change • Dyspnea • Circulation:pale • On endo with N/S 1BT • Citosol, Genso, Adrenalin • On CVC • Arrange PRBC 4u • 烤燈 use

  10. (17:45) • BP:77/52 mmHg, pulse:132, • Conscious not clear • Circulation: pale • Gelofusine 2 BT • L/R 2BT, N/S 1BT

  11. (17:52) • BP:64/33mmHg, Pulse:127 • Conscious not clear • Circulation: pale • Gelofusine • On foley (18:00) • BP:48/26mmHg, pulse:92 • Conscious not clear • Circulation: pale • Adrenalin • CPR • Sign DNR

  12. (18:10) • DC brain CT+ Abd CT • DC all X-ray • FAST echo (susp. pneumoportal) (18:20) • BP:55/32mmHg, pulse:110/min • Conscious not clear • Circulation: pale • PRBC:2u

  13. (18:30) recheck BP, Pulse • BP:50/24mmHg, pulse: 101 • Conscious not clear • Circulation: pale • Arrange portable CXR • (19:--) • BP: not available, Pulse: not available • EKG: standstill • Expire at 19:25

  14. Right 1st rib frx • Right 8th rib frx • Left 7th rib frx

  15. Diagnosis • Hypovolemic shock r/o retroperitoneal hemorrhage • Right elbow open fracture • Left wrist close fracture • r/o Right femoral head fracture • r/o pelvis fracture • Chest contusion with rib fracture • r/o ICH • r/o pneumoportal

  16. Discussion

  17. Hepatic portal venous gas (HPVG) (Pneumoportal)肝門靜脈氣體 • results from mesenteric vessels occlusion, leading to intestinal necrosis with a high mortality septic and hypovolemic shock, which was superimposed on intestinal distension and this resulted in intestinal hypoperfusion and submucosa damage. • Use of imaging studies, HPVG is more frequently detected than before • Diagnosis: Echo, CT better than X-ray • surgical intervention (necrosis, sepsis, peritonitis) • aggressive supportive care, including antibiotics and fluid supplement

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