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Trauma Case Conference

Trauma Case Conference. 2007-06-05 外傷科 李維哲 醫師. 何○○， 28y/o ， Male Chart No. ： 23656214 Date of ER visiting ： 2007-05-30 Mechanism of Injury ： Motor bike VS Car Helmet (+) Sent to our ER at 06:33 AM by EMT after CPCR. Patient Profile. Condition at Scene.

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Trauma Case Conference

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  1. Trauma Case Conference 2007-06-05 外傷科 李維哲 醫師

  2. 何○○，28y/o，Male Chart No.：23656214 Date of ER visiting：2007-05-30 Mechanism of Injury：Motor bike VS Car Helmet (+) Sent to our ER at 06:33 AM by EMT after CPCR Patient Profile

  3. Condition at Scene • Vital sign: BP ?/?；PR（-）；RR（-） • AVPU：Unrespondsive

  4. Traumatic Arrest • Traumatic arrest is a condition in which the heart has ceased to beat due to trauma to the chest area that involves the heart. It is a medical emergency which will always result in death without prompt advanced medical care. • Dead on arrival or DOA is a term used to indicate that a patient was found to be dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.

  5. Resuscitation • Start CPCR at 6:33 AM • On E-T tube Fr-7.0, fixed 22 cm • Adrenaline 1 amp IV • Adrenaline 1 amp IV • HR restore at 6:37 AM • HR 162/min • BP 140/60 mmHg

  6. Primary Survey and Management • Airway maintenance & cervical spine control • Breathing • Circulation • Disability • Exposure

  7. Primary Survey and Management • Airway • On oral endotracheal tube • Assume a cervical spine injury and ensure immobilisation • Breathing • Artificial ventilation • Decompression and drainage of tension pneumothorax/haemothorax • Closure of open chest injury

  8. Primary Survey and Management • Circulation with haemorrhage control • Stop external haemorrhage • Establish 2 large-bore IV lines (14 or 16 G) if possible with administer fluids • Disability • Make a rapid neurological ,no time to do the Glasgow Coma Scale • A V P U • Exposure

  9. Traumatic arrest • Large open wound over left forehead with skull open fracture and possible brain tissue exposure • Deep coma • Left lower chest wall abrasion • Right thigh deformity • Right knee laceration 5 cm

  10. Primary Survey and Management • FAST • Negative study • X-ray • CXR • Rt Knee • C-Spine • Pelvic

  11. Resuscitation • 6:58 AM • BP 50/20 PR 115/min SpO2 92% • On air splint for right thigh • Gelofusione • 備血PRBC6U，FFP 6U • 7:05AM • BP63/31 PR95/min SpO2 98% • Fluidchallange

  12. Resuscitation • 7:40AM • BP75/39mmHg PR96/min SpO2 99% • CheckCPK,CK-MB,Troponin-I • BrainCT • SerialX-ray

  13. NSConsultation • 8:55AM • BP66/32mHg PR88/min SpO2 100% • Dopamineuse • 9:10AM • BP121/71mmHg PR147/min SpO2 99% • Primaryclosureofforeheadandrightkneelaceration • AdmittedtoNSICU

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