Saving the life of a patient with severe traumatic shock due to a traffic accident

Multiple trauma patient, critical

On August 22, Master - Specialist Doctor 1 Nguyen Van Manh (Department of Abdominal Surgery, Military Hospital 175) said that the patient was admitted to the hospital in a lethargic state, with pale mucous membranes, low blood pressure, extensive skin abrasions on the right chest and abdomen, and peeling skin on the left calf. A quick ultrasound at the bedside detected a large amount of free fluid in the abdomen, thought to be blood, and free gas in the abdomen.

Immediately, the patient was intubated, given mechanical ventilation, fluid replacement, emergency blood transfusion, and vasopressor drugs to control blood pressure. The patient then underwent an emergency chest-abdomen-cranial CT scan to confirm the diagnosis and urgently activated the in-hospital "red alert" procedure.

After a quick consultation, the doctors determined that the patient had traumatic shock and multiple injuries due to a traffic accident. The injuries included closed abdominal trauma, extensive grade V liver rupture, grade 5 right kidney injury (crushed, severed right renal pedicle), crushed right adrenal gland, crushed pancreaticoduodenal mass, inferior vena cava tear just below the renal vein, massive abdominal hematoma, closed chest trauma, rib fractures, bilateral lung contusions, small amount of left pleural hematoma, and thoracic spine injury...

The patient was quickly operated on in an emergency. The surgical team, including doctors from the Department of Abdominal Surgery, Department of Nephrology, Department of Cardiovascular Surgery, and Department of Surgical Intensive Care, was mobilized to perform both intraoperative resuscitation and surgery to stop bleeding and treat injuries.

TP.HCM: Mổ khẩn cứu người đàn ông đa chấn thương vỡ gan, tuỵ, dập phổi - Ảnh 1. — Doctor checks patient after he is out of danger

6 hours of surgery to save the patient

Master - Doctor Nguyen Van Manh said that this was a particularly severe case of multiple organ rupture, requiring both resuscitation and surgery, in which the biggest challenge was to quickly control the patient's bleeding and blood loss, followed by having to deal with many complex organ injuries (in the liver, kidneys, pancreas), especially having to perform pancreaticoduodenal resection in an emergency situation - this is a very complicated specialized technique.
Due to severe blood loss and complex damage to abdominal organs, the patient was transfused with more than 5 liters of blood and blood products, and used 2 high-dose vasopressors to control blood pressure.

After more than 6 hours of surgery, the patient was transferred to the Surgical Intensive Care Unit for further monitoring and treatment. Here, the patient continued to be sedated, ventilated, given strong antibiotics in combination, maintained vasopressors, hemostatic drugs, continued to replace blood and blood products in proportion, screened and treated for coagulation disorders, acid-base disorders, kept warm to avoid hypothermia, and closely monitored for secondary bleeding in the abdomen.

After general treatment, the patient gradually stabilized, hemodynamics were stable (vasopressor drugs were reduced and stopped), there was no secondary bleeding in the abdomen, the ventilator was gradually removed and the endotracheal tube was removed after 2 days of admission.

Currently, the patient has overcome the critical stage and is still being specially monitored in the Department of Surgical Intensive Care, to prevent infectious complications and practice feeding through a tube to restore digestive circulation.

Major, Master - Specialist Doctor 1 Pham Tan Dat (Department of Intensive Care Surgery) said that surgery for multiple organ rupture in the abdomen is one of the urgent surgical emergencies that requires quick surgery, cannot be delayed and requires smooth coordination between specialties to reduce the risk of death due to severe internal bleeding, hemorrhagic shock, and improve the effectiveness of saving the patient's life. At the same time, it is necessary to coordinate resuscitation well to stabilize hemodynamics, avoid severe disorders arising after trauma and monitor and handle possible complications during and after surgery.

Most patients with traffic accidents that result in severe trauma to solid organs such as liver, kidney, spleen, etc. cause massive bleeding in the abdominal cavity with or without damage to other hollow organs, requiring open surgery to quickly and thoroughly screen for and treat the injury, stop bleeding, and avoid serious complications that can be life-threatening.

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