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Case report

Case report. 8901021 楊佩真. Photograph @ July 2005 Italy by BUBU YANG. Patient profile. GCS: E1V1M1 BP: 量不到 PR: 122/ 分 Endotracheal tube 7.5# 22cm 頸圈 chest tube left 32# with continuous bleeding NG tube IV CVP 輸血. 氣管正中 (+) breath sound: R: clear

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Case report

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  1. Case report 8901021 楊佩真 Photograph @ July 2005 Italy by BUBU YANG

  2. Patient profile • GCS: E1V1M1 • BP:量不到 PR: 122/分 • Endotracheal tube 7.5# 22cm • 頸圈 • chest tube left 32# • with continuous bleeding • NG tube • IV • CVP • 輸血

  3. 氣管正中 (+) • breath sound: R: clear • L: decreased • circulation: none • pupil 5.0/5.0 • non-reactive • skin/ mucosa: pale, cold. dry • bleeding from ear • active oozing from both ear • left > right with suspicious CSF leakage • abdomen : mixed distended

  4. Managements • 1418 arrive • on ventilation 7U 500 rate 16L • fiO2 100% • on EKG monitor • on pulse oximeter • 1420 brain CT with enhanced • fast no obvious fluid • CT scan brain right SDH: middle shifting • 1425 CVP • 1433 chest tube • left 32號 fix 12cm • total amount : 2300ml of blood

  5. 1445 BP 128/78 p 102 • 1445 N/S 1 BT • 1445 adrenaline 1/2 amp • 1450 N/S 1BT • adrenaline 0.5U • 1500 CPR開始 • 1500 HR 無 adrenaline 1 amp • CPR • NahCO3 4amp • calglon 1 amp • N/S 1BT • 1503~1506 adrenaline 1 amp • gelofusine 1BT • adrenaline 1BT • N/S 1000 1BT • 1510 adrenaline 1 amp • 1513 HR 無 adrenaline 1 amp • 1515 CPR machine • \ 1550 CPR stop • 1550 接ventilation 離院

  6. Image examination

  7. Impression • left massive hemothorax • left multiple rid fracture • left pneumothorax • right SDH • r/o skull base fracture.

  8. Discussion • Before arriving: • 小港: • 11am 車禍入小港 • Hypo-volemic Shock: • On CVP(Right side) • On endotracheal tube • X-ray  tension pneumothroax • On chest tube  hemothroax • Drainage :1100 ml • 要求轉長庚refused , except BP >100 • 輸血 in vain • CT scan壞 轉高醫

  9. Thanks for your attention! Photograph @ July 2005 Italy by BUBU YANG

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