trauma case conference
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 PresentationTRANSCRIPT
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2007-7-17外傷科 Intern 趙家宏
Trauma Case Conference
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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
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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
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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
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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
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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
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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
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2007/7/9 6:00 AM
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2007/07/09 6:00 Brain CT
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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.
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Lab
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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)
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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
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Chest X-ray 7:30chest tube 太深,外拉 2cm
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Abdomen CT <8:00 AM>
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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
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Impression
Traumatic SAH and IVH R’t pneumothorax left hemothorax Liver laceration Gr III-IV Hemopericardium r/o cardiac temponade
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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
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HBS surgery 7/9
1. Dx:Liver laceration
2. Laparotomy+hepatorrhaphy+choleycystostomy+ packing of liver
7/13
1. Liver packing gauze remove
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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