Case 1

1. Case 1 Farwaniyahospital

2. 36 y/o • Male. • Previously healthy. • Brought to casualty by ambulance after being hit by a car.

3. Cons, alert, oriented. • Complaining of • Abd pain • Right chest pain • Pelvic pain.

4. Vital sign • GCS 15/15. • A: maintaining airway. Spo 100% • B: reduce A/E on r.side. • C: BP 78/50 – P 112 .

5. Resuscitated by IVF. • BP 137/112. • O/E: • Chest: good A/E bilaterally. • Tender, guarding all over his abd. • Genitalia + DRE normal. • No blood at EXT. uretheralmeatus. • Foly`s cath. : hematuria

6. Investiagtion • FAST: peri-hepatic fluid collection. • CBC: HB 15.9 – WBC 26- PLT 228. • RFT: creat 68 – urea 1.1 Na 139 - k 3.5 • LFT : Normal.

17. pelvis

18. pelvis

19. CT showed - large pelvic hematoma (5x11x12cm) - pelvic fracture • Comminuted fracture of Lt. pubic bone • Inf. Pubic rami bilaterally - peri-hepatic free fluid ( no liver truma , no active bleeding)

20. Pt shifted to ICU • Pt prepared for surgery • After 2 hours : • Hb became 7.6. • BP 100/70. • Received 2 pints PRBC + 6 FFP. • SHIFTED TO OT

21. Surgical exploration • Large bladder tear ( dome ) • 2 lacerations around bladder neck • repaired with 2 layer closure • No intervention from surgical side • SPC and drain were fixed • Drain removed after 2 days • SPC removed after 2 wks

23. Thank you for listening