VCUDEATH AND COMPLICATIONS CONFERENCE

Introduction of Case

Complication Death

Procedure Ex. Lap, Splenectomy, Left anterior thoracotomy,

Ligation of bleeding intercostal vessels and Apthera Wound Vac Placement

Primary Diagnosis MVC with Blunt Trauma to thoracoabdominal

region, Cardiac Arrest, Positive Fast Exam with hypotension

Clinical History

66 y/o male was a delta trauma alert after being involved in a motorcycle versus truck accident. Pt skidded off his motorcycle and was run over by the truck. He was initially responsive in the field, then noted to be unresponsive in transport.

PMH:HTN, diabetes, CAD, obesity (BMI 43) PSURG: CABG FH: DM, HTN, CAD MEDS:ASA, Plavix SH:Unknown

Clinical History

The patient arrived in the emergency room with a GCS of 3 and pulseless

CPR- 10-15 minutes and intubated Bilaterally CT tubes Vitals- T-99 HR- 144 BP-80/60 NEURO-Pupils were fixed and dilated RESP- CTA B, no crepitus, large chest wall abrasions ABD- obese, soft distended PELVIS- stable Extremities- no signs of trauma FAST-positive LABS: Lac >20, Bun/Cr 30/ 1.9, Hbg-9, Plt 69, INR-1.8, PTT

>150

.

OR

Findings: Rupture spleen 1.2 L out of Left chest tube Left anterior thoracotomy Multiple Rib Fx and bleeding intercostals vessels ABG- 6.80/64/180/10 Lac >20 LABS: INR 5.8, Plt 40 and Fibrinogen 66 12 units of RBCs, 14 of FFP, 12 of platelets, 30 units of

cryo Requiring epinephrine, norepinephrine, and vasopressin

Analysis of Complication

• Was the complication potentially avoidable?NO

• Would avoiding the complication change the outcome for the patient?

• N/A

• What factors contributed the complication?

• Significant Blunt Trauma Injuries, Co morbidities

Teaching Points

Critically injured patients must receive high-quality care from the earliest post injury moment to have the best chance of survival

Mortality is increased in septic or severely injured patients with DIC

Intraoperative Indications to Perform Damage Control Operations-Initial acid-base status( ph, Base deficit, Serum lactate), Onset of coagulopathy, temp, etc.,

Emergency Department Thoracotomy is done for blunt trauma; 2% survival in patients in shock and less than 1% survival with no vital signs

.