Trauma M

1
Trauma MMJuly 24, 2007

• Mortality, ped struck multiple fractures, DIC

2
Case Summary

• 53 yo white male struck by motor vehicle
• On arrival 5/18/2007 _at_ 2125
• Awake, alert, following commands, breathing
  spontaneously, HD stable
• Dg with numerous facial lacerations and fractures
  of the temporal bone, C2, nasal, maxilla, right
  humerus and ulna, right tib/fib, left tibia,
  bilateral pevic ramus and right ribs 2-9

3

• Pt was stabilized in the ED with the intention to
  transfer to Shock trauma for definitive
  management but became HD unstable and required
  intubation and pressor support
• Pt was considered unstable for transport and was
  transferred to the SICU
• His support was hindered by inability to control
  his bleeding as he developed DIC refractory to
  aggressive resuscitation with blood products and
  factor VIIA
• After discussion with the family support was
  withdrawn

4
Delta code called 2121 arrived 2125

• Primary survey GCS 15, airway intact, trachea
  midline, spontaneously breathing, CTA bil but had
  severe nasal laceration with avulsion
• C-spine tenderness
• Circulation was adequate with palpable peripheral
  pulses
• Pelvis appeared stable
• Abdo soft, ND, but RUQ tenderness and abrasion
• Vitals 36.3, 81, 140/63, 100
• HCO3 21, WBC 21, Hb 15, plt 225
• Multiple fractures to face, ribs, R UE and bil LE

5
Continued care in ED

• All consults were called in ortho, ophtho,
  neurosurgery
• Bw 2125 0045
• BP variable 89/54 130/95, HR 75 -112, GCS 15
• Foley, Femoral 2145
• Bolus 7 L NS
• Aline 0015, intubated 0045, 2nd fem line 0120

6
Required more support

• 0120 Solucortef, 0126 Levo started
• 0220 bicarb
• 0345 labs 144/3.7/113/7/19/1.9/246 with AG 24,
  CBC 21/8/25/82, INR 2.5
• 0928 pH 7.1, LA 13 and worsening
• Pt received 4 FFP, 10 PRBCs, factor VII bw
  0300-0630 (change of care after 0630)
• Pt eventually underwent small laparotomy (DPL)
  and CT placement, fasciotomy R LE and midface
  stabilization (Foleys in nasopharynx)
• Received factor VII x 2

7
Final labs

• HCO3 15, iCa 0.55, AST 2500, ALT 1500, TB 0.4, AP
  235, WBC 5.6, Hb 6.4, plt 13, INR 2.0, PTT gt
  223, ABG 6.9/53/77/11
• Support was withrawn at 2205 5/19/07