Case 1

Farwaniya hospital

• 36 y/o • Male.• Previously healthy.• Brought to casualty by ambulance after being

hit by a car.

• Cons, alert, oriented.• Complaining of – Abd pain– Right chest pain– Pelvic pain.

Vital sign

• GCS 15/15.• A: maintaining airway. Spo 100%• B: reduce A/E on r.side.• C: BP 78/50 – P 112 .

• Resuscitated by IVF.• BP 137/112.• O/E:– Chest: good A/E bilaterally.– Tender, guarding all over his abd.– Genitalia + DRE normal.– No blood at EXT. uretheral meatus.

• Foly`s cath. : hematuria

Investiagtion

• FAST: peri-hepatic fluid collection.• CBC: HB 15.9 – WBC 26- PLT 228.• RFT: creat 68 – urea 1.1

Na 139 - k 3.5• LFT : Normal.

pelvis

pelvis

CT showed - large pelvic hematoma (5x11x12cm) - pelvic fracture –Comminuted fracture of Lt. pubic bone–Inf. Pubic rami bilaterally

- peri-hepatic free fluid ( no liver truma , no active bleeding)

• Pt shifted to ICU - Pt prepared for surgery

• After 2 hours :• Hb became 7.6.• BP 100/70.• Received 2 pints PRBC + 6 FFP.• SHIFTED TO OT

• Surgical exploration – Large bladder tear ( dome )– 2 lacerations around bladder neck– repaired with 2 layer closure– No intervention from surgical side– SPC and drain were fixed – Drain removed after 2 days– SPC removed after 2 wks

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