Beruflich Dokumente
Kultur Dokumente
- Extubated POD 0
- Bile leak on POD 5
- Taken back to OR on POD 7 for washout,
jejunostomy tube placement and omental patch
to leak from pancreatojejunostomy
- Remained in hospital an additional 3 weeks
with wound infection, intrabdominal fluid
collections
- 3 months after injury, back to baseline
Whipple s/p Traumatic Injury
-In SICU:
- Ventilator
- s/p ED thoracotomy, chest left open
- Massive Transfusion ongoing
- Level 1 utilized
- Warming measures
- Transfused PRBCs
- ACLS
- Coagulopathic, Acidotic, Hypothermic
- Went into heart failure and expired
approximately 6 hours after initial call.
Penetrating Aortic Injury
Case overview
Overall management
Overview of important aortic anatomy
Penetrating Aortic Injury
OR management
Nursing care
Examples of teamwork
Outcome
Challenges
Case 3
39M Auto vs Pedestrian, reportedly assaulted w
car in parking lot and pinned him against wall,
left leg near-complete amputation. No LOC
reported.
-In field:
- GCS 15
- BP 140/85
- SpO2: 97%
- Isolated left leg mangled extremity
- Thigh tourniquet placed
-In ED:
- GCS 15, responsive and appropriate
- BP: 98/68
- HR: 128
- SpO2: 100% on RA
- Left leg w large bleeding wound, exposed bone
and muscle, no sensation, no movement.
- Left thigh tourniquet in place and wound
hemostatic.
Traumatic Amputation
-In ED:
- Patient judged to be able to protect airway
- IVs placed
- Started blood
- Secondary Survey performed without signs of
other injuries
- CXR, PXR, FAST neg
- Communicated to OR of our arrival
- Communicated to Ortho to meet in OR
-In OR:
- Discussed w patient the possibility of having
amputation
- Placed pneumatic tourniquet above field tourniquet
- Removed the field tourniquet prior to prep and drape
- 3 main arteries to foot completely lacerated
- Popliteal artery exposed and confirmed intact
- Tibeal nerve was completely transected/shredded
- Discussed case w Ortho attending and another
trauma attending and formed a consensus agreement to
proceed w completion amputation.
Traumatic Amputations
Nursing care
Examples of teamwork
Outcome
Challenges
Summary