RTA + Liver tear

Question 1

Young male patient came in motor cycle RTA .. Hypotensive and tachycardic.

Q1. How will you assess the patient ?

Answer 1

By ATLS protocol A-E assessment

Question 2

Q2: what are the general principles of ATLS ?

Answer 2

Airway with C-spine
Breathing
Circulation
Disability
Exposure

Question 3

Q3: After primary assessment you ordered a chest Xray ,
Given this Xray what is your findings?

Answer 3

AP CXR showing Black shadow on the lt lung and shifting of trachea to opposite side, Obliteration of lt costophrenic angle, presence of surgical emphysema
Dx; Lt T. Pneumothorax

Question 4

Q4. How will you manage this?

Answer 4

Urgent needle decompression in the lt 5th ICS MCL followed by applying chest tube connected to underwater seal.

Question 5

Q5. Now the patient is shocked , what is the classes of hemorrhage ?

Answer 5

Class 1 – Losing < 750 ml // HR < 100 // Bp n // RR 14-20 // UOP >30 ml
Class 2 – Losing 750-1500 // HR 100-120 // Bp n // RR 20-30 // UOP 20-30ml
Class 3 – Losing 1500-2000 // HR 120-140 // Bp dec. // RR 30-40 // UOP 5-15ml
Class 4 – Losing > 2000 // HR >140 // Bp dec. // RR >35 // UOP < 5ml

Question 6

Q6: How will you manage the circulation of this patient ?

Answer 6

Control ext source of bleeding
– insert 2 wide pore cannulas
– draw blood for routine blood test and blood group and cross matching and order 4 units of matched blood.
- start Pt on 1 -1.5 L of crystalloids within 1hr. No response  start blood transfusion

Question 7

Q7. How will you monitor the response of the patient?

Answer 7

Monitor by – > Bp / CRT / HR / UOP / Mental status / U&E
And what will you do if you noticed he is not improving?
Inform my consultant and HDU specialist – > admit to HDU and start blood transfusion (Consider central line insertion)

Question 8

Q8. A CT was done for the patient and showed the following, What is your diagnosis?

.

Answer 8

Lesion of liver most likely liver tear

Question 9

Q9. Management of liver tear? Grades?

Answer 9

According to the stability of the pt and grade of injury
Conserve – > Blood transfusion and monitoring response
Surgical – > Damage control / Packing Repair /Resection
Grades; Read It well :D

Question 10

Q10: Was CT a good investigation for this patient?

Answer 10

No , as pt is unstable I would have gone with FAST