List Archives

Fri Feb 13 06:25:00 GMT 2009

> Adult female, pedestrian vs train.
>
> Arrives in extremis, shocky.  Looks like she's been hit by a train.
>
> Injuries will be found to include flail chest with tension pneumothorax
> and pulmonary contusion; high-grade splenic injury with active bleeding
> and clinically evident hemoperitoneum; a left renal disruption with
> retroperitoneal hematoma; stable pelvic rami fractures; and two open,
> angulated, mangled extremities with diminished pulses (one arm, one
> leg).
>
> Airway control, ED thoracostomy, massive transfusion initiated and taken
> promptly to OR for damage-control procedures (splenectomy and packing,
> extremity debridement, reapproximations and ex-fixes).
>
> To ICU post op, recovers nicely over a few hours: warm, no acidosis,
> normotensive, predictably anemic and thrombocytopenic but without
> coagulopathy.  She is moving all extremities and has a negative brain
> CT.  All the surgeons are considering her survival unexpected, and her
> stable condition just short of astonishing.  She has good apparent
> circulatory, sensory and motor function in her fixators.
>
> The orthopedists are anxious to have a more methodical crack at her arm
> and leg: multiple complicated surgeries taking several hours.
>
> How long should she rest in the ICU before definitive extremity repairs?
>
> Pret Bjorn, RN
> Bangor, ME USA
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
Pret

Either fix at 48 hours or AFTER day 8 - this is what the best applied
basic science would suggest for least inflammatory complications.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa

List Archives

For your convenience, find the Trauma List Archive Below

Sequencing of complex ortho in major multisystem injury