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Case Presentation

Case Presentation. Intern 蔡孟峰. Chief Complaint. Traffic accident last midnight(06/03), transferred from “ 劉光雄” Hospital. Present Illness. The 21-year-old male is well-being before.

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Case Presentation

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  1. Case Presentation Intern 蔡孟峰

  2. Chief Complaint • Traffic accident last midnight(06/03), transferred from “劉光雄” Hospital

  3. Present Illness • The 21-year-old male is well-being before. • Last night, he went out with his friends, sitting in the middle of the backseat. Around 22:00, the car crashed a wire pole. • He didn’t know anything until he woke up in “劉光雄” hospital. Several management were done there.

  4. Present Illness • Diagnosis at 劉光雄 hospital • Consciousness drowsy • Head injury with brain swelling • Right thigh painful deformity • Right femur fracture • Right leg 固定在護木位置 • Then, he was transferred to our ER for further management.

  5. The Status on Arrival • Consciousness : alert, E4V5M6 • Respiratory Rate : 10 ~ 24 / min • Pulse Rate : 127 /min • Blood Pressure : 163 / 93 mmHg • Body Temperature : 36.8 oC • At ER, right femoral fracture and dyspnea were told.

  6. Initial Assessment • A : patent airway • B : spontaneous breathing • C : radial pulse (+) • Pulse rate : 127/min • Blood pressure : 163/93 mmHg • D : E4V5M6 • E : trauma at • Left lower pulmonary area • Epigastric area • Right upper femoral area

  7. Focused history • Allergic : denied • Medication : denied • Past medical history : denied • Last meal : unknown • Events: traffic accident

  8. CBC GOT/ GPT/ BUN/ Creatinine/ Sugar/ Na/ K PT/ APTT Ethanol Cross matching/ PRBC 2U Lactated Ringer IVD : 500c.c. NPO Nasal Cannula 12 lead EKG 頸圈固定 X-ray Skull AP, Lateral Chest AP Spine AP, Lateral, Neck Femur Pelvis CT scan : abdomen 適應症: R/O internal bleeding Plan

  9. Available Lab Data

  10. Available Lab Data

  11. Management • 01 : 00 • Gelofusine 500 c.c. IV • PRBC 2U st • 01 : 10 • SpO2= 89% • O2 : 3 l/min • 01 : 15 • BP : 138/66 mmHg, pulse : 136 /min • 開始輸PRBC

  12. Management • 01 : 25 • BP : 123/53 mmHg, pulse : 137 /min, SpO2 : 100% • X-ray survey • 01 : 30 • CT-scan (abdomen) • 適應症: R/O internal bleeding • ?? FAST scan • Fluid accumulation over • Morison’s pouch

  13. Image

  14. 劉光雄醫院

  15. Abdominal CT

  16. Abdominal CT

  17. Abdominal CT

  18. Abdominal CT

  19. Abdominal CT

  20. Abdominal CT

  21. Abdominal CT

  22. Abdominal CT

  23. Abdominal CT

  24. Abdominal CT

  25. Abdominal CT

  26. Abdominal CT

  27. Abdominal CT

  28. Abdominal CT

  29. Abdominal CT • Report • Splenic laceration with hemoperitonum. • Left pneumothorax. • Contusion hemorrhage at both pulmonary lower lobes. • Pelvic fracture at bilateral superior rami of pubis, right ilium and right aspect of sacrum. • Soft tissue swelling over left lower flank.

  30. Management • 01 : 55 • O : internal bleeding • on Foley • 02 : 00 • BP :120/54 mmHg, HR : 123 /min, SpO2 : 100% • BP :123/49 mmHg, HR : 144 /min, SpO2 : 98% • L/R 500 c.c. IV st • BT PRBC 2U FFP 6U • Transamin 2Amp IV • Vit C / Amp IV Hematuria

  31. Management • 02 : 20 • BP : 100/40 mmHg, HR : 170 /min • R/O internal bleeding, hematuria • Admission to GS • Cefazolin 1g vial IV • Gentamicin 80mg/ Amp IM • 7ESI-2 • On CVP • 顏面縫合 Nylon 6-0

  32. Management • 02 : 35 • BP : 132/51 mmHg, pulse : 119 /min • 02 : 45 • BP : 121/63 mmHg, pulse : 122 /min, BT : 35.6oC • 離開ER

  33. Diagnosis at ER • Right femoral shaft fracture AIS=2 • R/O linear laceration AIS=3 • R/O acetabular fracture, bilateral • Left occult pneumothorax AIS=3 • R/O pubic ramus fracture • Renal contusion • R/O U-B rupture ISS=22

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