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    Santanico De CVT deoza
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    A 32-year-old male presented to the trauma conference with a stab wound to his left upper back from 1 hour prior. His vitals were stable on oxygen supplementation. Exams found decreased breath sounds on the left and a 2cm wound without active bleeding. eFAST scans were initially negative. CXR showed a left hemothorax and mediastinal shift. CT scan confirmed a massive left hemothorax. The patient underwent a left thoracotomy where 1,500ml of blood was evacuated. Bleeding was controlled with sutures. The patient was stable in the postoperative period.

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    A 32-year-old male presented to the trauma conference with a stab wound to his left upper back from 1 hour prior. His vitals were stable on oxygen supplementation. Exams found decreased breath sounds on the left and a 2cm wound without active bleeding. eFAST scans were initially negative. CXR showed a left hemothorax and mediastinal shift. CT scan confirmed a massive left hemothorax. The patient underwent a left thoracotomy where 1,500ml of blood was evacuated. Bleeding was controlled with sutures. The patient was stable in the postoperative period.

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    1 views14 pages

    Trcon 248

    Uploaded by

    Santanico De CVT deoza
    A 32-year-old male presented to the trauma conference with a stab wound to his left upper back from 1 hour prior. His vitals were stable on oxygen supplementation. Exams found decreased breath sounds on the left and a 2cm wound without active bleeding. eFAST scans were initially negative. CXR showed a left hemothorax and mediastinal shift. CT scan confirmed a massive left hemothorax. The patient underwent a left thoracotomy where 1,500ml of blood was evacuated. Bleeding was controlled with sutures. The patient was stable in the postoperative period.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 14

    Trauma conference

    24 th August2023
    Male 32 yo :Stab wound at Lt.upper back 1 hr PTA

    BP 90/70 Pr 95 RR 24 O2 sat 100 (O2 mask c bag 10 LPM)


    Primary survey
    A:patent can talk no stridor
    B:trachea in midline ,decrease breath sound at LLL
    C:pulse 2+ No external gross bleeding
    D:E4V5M6 pupil 3mm BRTL
    E:LW 2 cm at lower border of Lt .scapula area, present of
    subcutaneous emphysema, no sucking wound, no active bleeding,
    Adjusted to primary survey
    eFAST(2.00 AM):negative
    eFAST(2.15 AM):negative
    eFAST(2.30 AM):negative
    eFAST(3.00 AM):negative

    CXR:Trachea in midline ,mediatinum shift to Rt.,Hemothorax in Lt.lung


    Film Pelvis:No fracture ,no dislocation
    Secondary survey
    A: NO Allergy
    M: No current medication
    P: no previous surgery
    L: 01.30 AM
    E:1hr PTA stabbed in Lt.upper back area by knife (1 time hit)
    Adjuncted to Secondary survey
    CTA chest:Massive Lt.hemothorax c mediatinum shift to Rt.Not seen extravasation.
    Management
    • Lt. ICD insertion (No.32)mark 8 cm
    • Air+Blood 600 ml initial -> 1,500 ml in 1 hr
    BP 70/40 PR 102 with transient volume responder
    Management
    • PRC 4 u iv push
    • LRS iv load 1500 ml
    • On ETT no.7.5 depth 22
    • Set OR for Lt.Thoracotomy c remove clot c stop bleeding
    CXR
    CTA
    Plain axial
    CTA
    CTA
    Lung window
    Operative finding
    Lt.thoracotomy c suture stop bleeding c chest toilet c clot removal

    Position Rt lateral decubitus


    Finding
    • Blood clot 1,500 ml
    • active bleeding at laceration wound at
    superior segment of LLL
    • No active bleeding from heart and great
    vessels
    • Stab wound at posterior axillary line 2 cm.
    at T4 level.
    Operation

    • Lt.thoracotomy was done.


    • Blood clot was removed.
    • Identify bleeding at superior segment of LLL.
    • Suture and ligation with prolene 4-0 was done.
    • Bleeding was checked and stopped.
    • ICD no.28 was inserted.
    • Chest wall and ribs was closed by vicyls 2-0.
    • Skin was closed by vicyls 3-0.
    Procedure
    Op time 1 hr 25min (04.50 AM -6.15 AM)

    Blood loss 2500 ml


    Blood component given 2859 ml
    FFP 4 u
    PRC 3 u
    SDP 1 u
    LPPC 1 u
    7.5% NaCHO3 50ml *2 amp
    10%Ca gluconate 1 gm iv*4 dose
    Transamine 1 gm iv*1 dose
    Urine out put 400 ml
    Post OP
    Day1
    OPD Follow up

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