Polytrauma case that required multiple interventions!
from @nirhusmd
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High speed motorcycle crash
Injuries open book pelvic fractures with bladder injury, small bowel injury, large bowel injury, bleeding into abdomen from mesenteric vessels (blood supply to intestines), splenic injury with active bleeding, left diaphragm rupture, bilateral chest injuries including multiple rib fractures and lung injuries with active bleeding, and minor head injury (patient was helmeted)
Interventions:
1. Pelvic binder- a type of corset which was used to reduce the open book fractures in the pelvis and help reduce bleeding similarly to a tourniquet (see previous X-ray post)
2. ELAP (damage control surgery)- exploratory laparotomy, open the abdomen and pack the abdomen with laparotomy pads to help control bleeding.
3. Control bleeding in abdomen by suturing all visible bleeding vessels
4. Resect injured bowel and not repair at this time. Leave the bowel parts in discontinuity (blind ends not repaired) simply to control stool spillage temporarily.
5. Splenectomy
6. Left diaphragm repair
7. Chest tubes to both sides- Drain hemopnumothorax (blood and air in chest cavity)
8. Left thoracotomy with clamping of aorta and repair of left lower pulmonary vein injury with active bleeding into chest.
9. IR (interventional radiology)- angiogram and plug additionally bleeding sources
10. Bladder injury repair
11. Central lines and arterial lines for monitoring
12. Leave the belly open
The patient miraculously survived!