Trauma Case Trauma Case PresentationsPresentations

Case #1Case #1EMS Report:EMS Report:–– 26 year26 year--old man shot multiple timesold man shot multiple times–– Vomited with probable aspiration en routeVomited with probable aspiration en route–– Vitals upon arrival to trauma bayVitals upon arrival to trauma bay

90/P, HR 120, RR 3090/P, HR 120, RR 30

–– WorkupWorkup--Primary surveyPrimary surveyAirway intactAirway intactDistant but audible bilateral breath soundsDistant but audible bilateral breath soundsSecond vitals: 85/P, HR 120, RR 30Second vitals: 85/P, HR 120, RR 30ABG: 7.25/30/120/ ABG: 7.25/30/120/ --1414

Case #1: Secondary surveyCase #1: Secondary survey

Lethargic but arousableLethargic but arousableGun shot wounds as Gun shot wounds as shownshownMoves all extremitiesMoves all extremitiesBleeding from GSW at Bleeding from GSW at inguinal ligamentinguinal ligamentPulseless RLEPulseless RLE

Case #1Case #1--ManagementManagement

AirwayAirwayIV accessIV accessRadiologic studiesRadiologic studiesBlood workBlood workNext set of vitals: 70/P, HR 140, RR 30Next set of vitals: 70/P, HR 140, RR 30Resuscitation Resuscitation

Radiologic studiesRadiologic studies

Operative ManagementOperative Management

First incisionFirst incision–– Operative proceedings and findingsOperative proceedings and findings–– Resuscitation; blood product ratiosResuscitation; blood product ratios–– Antibiotics ?Antibiotics ?Next moveNext move–– How to manage the How to manage the poplitealpopliteal–– OrthopedicOrthopedic’’ss rolerole

ICU ManagementICU ManagementSedation and ventilation in a patient with Sedation and ventilation in a patient with an open abdomenan open abdomenTiming of operative returnTiming of operative return

Second OperationSecond Operation

Management from AnesthesiaManagement from Anesthesia

Management from SurgeryManagement from Surgery

Follow up careFollow up care

CKCK--40,00040,000–– Workup and managementWorkup and management

RLE vascular imaging choicesRLE vascular imaging choices

Case #2Case #2EMS report: 74 yearEMS report: 74 year--old driver in highold driver in high--speed speed MVCMVC–– Belted, no airbag, + LOCBelted, no airbag, + LOC

Upon arrival to trauma bay:Upon arrival to trauma bay:–– Vitals 130/P, Vitals 130/P, afibafib 100, RR 30100, RR 30–– ABGABG--7.34/42/80 BD7.34/42/80 BD--55

Primary surveyPrimary survey–– Airway; tongue dropping backAirway; tongue dropping back–– Shallow breath sounds R>LShallow breath sounds R>L–– AccessAccess–– GCSGCS--55

RadiologyRadiology

ManagementManagement

ResuscitationResuscitationNext stepsNext steps……..

Chest tube placed, intubationChest tube placed, intubation

Head CTHead CT

Chest CTChest CT

Operative Management:Operative Management: Subdural evacuationSubdural evacuation

Anesthesia PrinciplesAnesthesia Principles

Management of Traumatic Aortic Management of Traumatic Aortic LacerationLaceration

Endovascular Options?Endovascular Options?In setting of head injury?In setting of head injury?–– Issues with anticoagulationIssues with anticoagulationICU CareICU Care–– Glucose control with head injuryGlucose control with head injury–– Rate control for Rate control for afibafib–– PreopPreop care to limit shear effect of injurycare to limit shear effect of injury