Basilio A, Coria A, Chávez R, Delgadillo S, Soto A, Espinosa R, Quiñones A

Language: Spanish
References: 12
Page: 97-101
PDF size: 82.08 Kb.

ABSTRACT

A 54 year old patient was attended in the ER, with 1 hour history of a car accident. When he arrived he was anxious, with pelvic pain, incapacity to mobilize, his vitals were BP 110-70 mmHg, CR 120x´ RR 26x´ central temperature 33°C, blood gas,pH 7.25, SaO₂ 85, BE –10, he received oxygen support with reservory mask, increasing the saturation to 95%. The plain films revealed pelvis fracture type C, thus he was treated with external fixators, semiopen diagnostic peritoneal lavage was performed, and it was positive at aspiration, the patient became rapidly hypotensive, he was intubated, non responsive bradicardia, finally cardiac arrest. Reason why left anterolateral thoracotomy was performed to give cardiac massage. And camping of the aorta, the patient responds favorably, sinus rhythm was registered, then was taken to the operating room. Where a grade IV hepatic injury was found, a zone III retroperitoneal haematoma, perihepatic packaging was performed, then he was taken to the ICU con BP 90-50 mmHg, CR 100x´, central temperature 35´C, BE –9, SaO₂ 90%, pH 7.30. In the ICU presents an arrhythmia then cardiac arrest and death, 28 hours after of his arrive at emergency room.

REFERENCES

1. Shoemaker WC, Pietzman AB, Bellamy R. Resuscitation from severe hemorrhage. Critical Care Medicine 1996; 24(2): 12-21.

2. Vaagenes P, Ginsberg M, Ebmeyer U. Cerebral resuscitation from cardiac arrest. Pathophysiologic mechanisms. Critical Care Medicine 1996; 24(2): 57-67.

3. Gisvoid SE, Stertz F, Abramson N. Cerebral resuscitation from cardiac arrest. Treatment potentials. Critical Care Medicine 24(2): 69-79.

4. Marion DW, Ginsberg M, Katz LM. Resuscitative hypothermia. Critical Care Medicine 24(2): 81-89.

5. Mattox K, Feliciano E. Trauma. Moore. Ed. McGraw-Hill.

6. Rubel I, Kloen P, Borens O. External fixation for pelvic ring injuries. Techniques in Orthopaedics 2002; 17(2): 221-227.

7. Morey A. Early versus delayed fixation of pelvic ring fractures. Journal of Urology 2004; 172(6 Part 1 of 2) 2510.

8. Chiu FY, Chuang TY. Treatment of unstable pelvic fractures use of fixator external. Journal of Trauma and Critical Care 2004; 57(1): 141-145.

9. Vargo D, Battistella F. Abreviated thoracotomy and temporary chest closure. An application of damage control after trauma. Archives of Surgery 2001; 136(1): 21-24.

10. Bilkovsky R, Rivers E. Targeted resuscitation strategies after injury. Current Opinion in Critical Care. 2004; 10(6): 529-538.

11. Bochicchio H, Scalea T, Joshi M. Long term impact of damage control laparotomy, a prospective study. Journal of trauma-Injury infection and critical care 2004; 57(6): 1379.

12. Loveland J, Boffard K. Damage control in the abdomen. British Journal of surgery 2004; 91(9): 1095-1101.