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Case PresentationRTA (Polytrauma)Case PresentationRTA (Polytrauma)
King Fahad Hospital,HofufKSA
King Fahad Hospital,HofufKSA
Age:19 years sex:maleCitizen:Saudi Arabia
Age:19 years sex:maleCitizen:Saudi Arabia
RTA victim brought by Red Crescent.•Unconscious •Bleeding from nose & ears.
RTA victim brought by Red Crescent.•Unconscious •Bleeding from nose & ears.
Date:16/06/1432Time:3:32 AMPlace:ER of KFHH
Date:16/06/1432Time:3:32 AMPlace:ER of KFHH
ER Doctor’s survey assessment and management.ER Doctor’s survey assessment and management. Primary survey •Breathing: labored•Skin: Pale, cool, clammyABC•Patent airways.•Respiratory rate:22/min.•Saturation 87% on O2 mask.•BP-90/50.•Pulse:90/min.
Primary survey •Breathing: labored•Skin: Pale, cool, clammyABC•Patent airways.•Respiratory rate:22/min.•Saturation 87% on O2 mask.•BP-90/50.•Pulse:90/min.
ER Doctor’s survey assessment and management.ER Doctor’s survey assessment and management.
Secondary Survey•HEENT: Bleeding from Nose and both Ears•Neck: ? Trauma•Lungs: Clear•Abdomen: Non-tender•Back: Unable to assess•Extremities: possible hip dislocation, present distal pulses•Neuro: GCS not recorded
Secondary Survey•HEENT: Bleeding from Nose and both Ears•Neck: ? Trauma•Lungs: Clear•Abdomen: Non-tender•Back: Unable to assess•Extremities: possible hip dislocation, present distal pulses•Neuro: GCS not recorded
ER Doctor’s survey assessment and managementER Doctor’s survey assessment and management
Initial management•Neck collar applied.•IV line inserted.•Ringer Lactate started•Anesthetist called for intubation•CBC, Biochemistry and cross match sent•4 units PRBC & 2 units FFP requested.•ICU doctor called for central line.
Initial management•Neck collar applied.•IV line inserted.•Ringer Lactate started•Anesthetist called for intubation•CBC, Biochemistry and cross match sent•4 units PRBC & 2 units FFP requested.•ICU doctor called for central line.
ER Doctor’s survey assessment and management.ER Doctor’s survey assessment and management.
• Neurosurgery.• ENT • GS • OrthoWere called for further assessment and
management.
• Neurosurgery.• ENT • GS • OrthoWere called for further assessment and
management.
NeurosurgeryNeurosurgery
• Patient was already intubated on MV.• Severely bleeding from nose and both ears with
CSF leakage.• No cut wound on the head and face noted.• GCS-6/15• Rt Pupil 4-5 mm non reacting.• Lt Pupil 2-3 mm sluggish reaction.• Requested for CT brain and C-spine after
stabilizing the vitals.• ICU bed requested for possible admission
• Patient was already intubated on MV.• Severely bleeding from nose and both ears with
CSF leakage.• No cut wound on the head and face noted.• GCS-6/15• Rt Pupil 4-5 mm non reacting.• Lt Pupil 2-3 mm sluggish reaction.• Requested for CT brain and C-spine after
stabilizing the vitals.• ICU bed requested for possible admission
ENTENT
• Posterior Nasal pack applied with Foley’s catheter.
• Anterior nasal pack applied both side.• Both Ear pack applied.• Follow up.
• Posterior Nasal pack applied with Foley’s catheter.
• Anterior nasal pack applied both side.• Both Ear pack applied.• Follow up.
OrthoOrtho
• Clinically Rt hip dislocation.• X-ray pelvis requested after stabilization
• Clinically Rt hip dislocation.• X-ray pelvis requested after stabilization
General surgeryGeneral surgery
• Vitals taken• Saturation 95-100% on MV.• BP 60/30• Pulse 76• CBC and biochem result checked.• 2 units PRBC started.• Foley's catheter inserted.• Requested ultrasound abdomen and chest xray.
• Vitals taken• Saturation 95-100% on MV.• BP 60/30• Pulse 76• CBC and biochem result checked.• 2 units PRBC started.• Foley's catheter inserted.• Requested ultrasound abdomen and chest xray.
General surgeryGeneral surgery
CBC & Biochemistry results:•MCV-80.1•MCHC-32.1•HGb-10.2•WBC-6.13•RBC-3.9 X 1O^9•PLATELET-215
CBC & Biochemistry results:•MCV-80.1•MCHC-32.1•HGb-10.2•WBC-6.13•RBC-3.9 X 1O^9•PLATELET-215
General surgeryGeneral surgery
• GLUCOSE FASTING-16• CREATININE-150• UREA-3.1• SODIUM-147• ALT-249
• GLUCOSE FASTING-16• CREATININE-150• UREA-3.1• SODIUM-147• ALT-249
General surgeryGeneral surgery
• Ultrasound abdomen result shows no free fluids.
• Chest Xray normal• Admitted under GS for observation but
patient is mainly Neurosurgical case so handed to Neurosurgery for further management.
• Ultrasound abdomen result shows no free fluids.
• Chest Xray normal• Admitted under GS for observation but
patient is mainly Neurosurgical case so handed to Neurosurgery for further management.
CXRKFHH
NeurosurgeryNeurosurgery
• 1 Unit of FFP started.• 1 L RL started fast.• Saturation was dropping to 70%.• Taken on ambu bag.• Bp-60/40• HR-40• Anesthetist was called.• 1 mg atropine given
• 1 Unit of FFP started.• 1 L RL started fast.• Saturation was dropping to 70%.• Taken on ambu bag.• Bp-60/40• HR-40• Anesthetist was called.• 1 mg atropine given
NeurosurgeryNeurosurgery
• 5 mcg/kg/min Dopamine infusion was started which was increased to 20 mcg/kg/min later.
• 2 units PRBC started.• 1 L ringer lactate started.• Blood for PT,PTT,INR was sent.• Vitals taken again.• SPO2-96% on MV.• BP-90/60.• HR-125/min
• 5 mcg/kg/min Dopamine infusion was started which was increased to 20 mcg/kg/min later.
• 2 units PRBC started.• 1 L ringer lactate started.• Blood for PT,PTT,INR was sent.• Vitals taken again.• SPO2-96% on MV.• BP-90/60.• HR-125/min
NeurosurgeryNeurosurgery• Ortho specialist ordered for portable Xray pelvis.• Admitted under Neurosurgery in ICU for suspected
skull base fracture.• CT Brain & C-spine was not done because
hemodynamically unstable.• Patient was shifted to ICU for further
management,accompanied by Neuro doctor.• Total blood loss was 1000 ml(approx)• Total 6 L fluids given.• Total 4 units PRBC given• Total 1 unit FFP given(not available more)
• Ortho specialist ordered for portable Xray pelvis.• Admitted under Neurosurgery in ICU for suspected
skull base fracture.• CT Brain & C-spine was not done because
hemodynamically unstable.• Patient was shifted to ICU for further
management,accompanied by Neuro doctor.• Total blood loss was 1000 ml(approx)• Total 6 L fluids given.• Total 4 units PRBC given• Total 1 unit FFP given(not available more)
X ray PelvisKFHH
THANK YOUTHANK YOU
Prepared by:Dr.ASLAM PERWEZNeurosurgery
