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Case Conference- 急診外科

Case Conference- 急診外科. Presenter: Int. 黃士財 Director: 林杏麟醫師 Date: 2006-09-05. Patient profile:. Name: 許╳恩 Gender: male Age: 10 years old ID: 23088220 Time: 2006-09-02, around 6:00pm. Pre-hospital Assessment. Incident: crushed by a sport utility vehicle near 龍華國中

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Case Conference- 急診外科

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  1. Case Conference-急診外科 Presenter: Int.黃士財 Director: 林杏麟醫師 Date: 2006-09-05

  2. Patient profile: • Name: 許╳恩 • Gender: male • Age: 10 years old • ID: 23088220 • Time: 2006-09-02, around 6:00pm

  3. Pre-hospital Assessment • Incident: crushed by a sport utility vehicle near 龍華國中 • Brought by an 119 ambulance with neck collar, Spinal Broad, and Simple mask (O2: 10L/min) • 否 24 130 155/75 E1V1M1否 20 134 157/72 E1V1M1 • 抵院時基本狀態：Respond to pain, RR: 10~24/min, BP: 152/110 mmHg, Pulse: 149 bpm, BT: 37.2’C， GCS score: E1V1M1

  4. Primary ABCD

  5. Airway • Neck collar • Airway obstruction sign: Cyanotic,

  6. Breathing • Respiration rate:18/min→On simple mask, O2 : 6L/min • No trachea deviation • Breathing sound: bilateral rale and rhonchi • Subcutaneous cripitus: right side • Echo finding: no lung sliding, 霧霧的→Right thoracostomy was performed at 6:25pm • SpO2: 94%

  7. Circulation • Check four limbs pulse: • BP: • 左手： BP: 130/80mmHg, pulse: 142/min • 右手： BP:146/72mmHg, pulse: 134/min • 右腳： BP:骨折無法測量, pulse: OK • Peripheral circulation: • Skin color: red • Temperature: warm • Capillary refilling time: not performed • Bleeding: • 懷疑胸腔內持續出血 • FAST: Morrison’s pouch, Splenic fossa, cul-de-sac, pericardium, no fluid acclumination.

  8. Disability and Exposure • GCS score: E2V2M4, 總分：8 • Pupil: sluggish, right 5mm/5mm • 移除衣物，在背部發現有一大片Abrasion wound.

  9. Menagement • Neck collar, Simple mask 6L/min, Pulse oximetry, • EKG monitor, Peripheral line • N/S 1 bot • On chest tube, right and left side • Lab exam: CBC, PT/PTT, Sugar, BUN/Cr, Na/K, GOT/GPT, CPK/CKMB/Tropo-I • Image: • X-ray: Chest ,Elbow (R), Humor (L), Low leg (R), Femur (R), Pelvis • CT: C-spine, Head (with and without contrast), chest, abdomen

  10. Lab data

  11. Image Finding

  12. Image finding • CT of Chest: • Bilateral pneumothorax and suspicious bilateral hemothorax s/p right chest tube insertion with subcutaneus emphysema at right lateral chest wall. • Deformity of left 5th, 6th, 7th, 8th and 9th ribs, suspect old fracture. • CT of head: • Subgaleal hematoma at left temporo-parietal scalp. • Left maxillary hemosinus; sphenoid, right frontal,right ethmoid and right maxillary sinusitis/hemosinuses.

  13. 19:15 BP: 142/66mmHg, PR: 134/min • 19:45 BP: 141/96mmHg, PR: 142/minconscious: clear (while performed CT) • 20:10 BP: 140/70mmHg, PR: 135/min BT: 36.6’C, sPO2: 95% • Admitted to 5C at 9:15, all purpose 35% 10L/min

  14. 急診初步診斷 • Traumatic left pneumothorax and right hemopneumothorax /c lung contusion • Traumatic asphyxia • Right femoral bone fracture • Left upper arm crushing injury • Back contusion /c abrasion • Head injury /c scalp abrasion

  15. Current condition • Remove bilateral chest tube on 9/4

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