|
| Case 1 | Case 2 | Case 3 |
|
| History | 65-year-old female front seat passenger side on collision with truck wearing a seatbelt | 60-year-old female front seat passenger head on collision with truck wearing a seatbelt | 32-year-old male back seat passenger when head on collision with van wearing a seat belt |
|
| Assessment and emergency management | Airway intact | Airway intact | Airway intact |
| Breathing uncompromised | Breathing uncompromised | Breathing uncompromised |
| BP 105/64 mmHg, HR 64 bpm | BP 84/47 mmHg, HR 60 bpm | BP-109/90, HR 73 bpm |
| GCS 15/15 | GCS13/15 | GCS 15/15 |
| Positive seatbelt sign—tender lower abdomen, no guarding or rigidity | Positive seatbelt sign—tender with guarding in left upper | Positive seatbelt sign—abdomen initially soft and nontender on examination but progressed to acute rigid abdomen while initial investigations being performed |
| BP increased to 118/74 following fluid resuscitation | |
|
| Radiological findings | Chest X-ray-fractured left clavicle | FAST- small amount of free fluid around liver and spleen | |
| Pelvic X-ray-comminuted fracture of right femoral shaft with avulsion of lesser trochanter and dislocation of left hip prosthesis | CT spine-undisplaced fracture of left lamina of L1 vertebra | Patient became haemodynamically unstable necessitating emergency surgery |
| FAST scan-free fluid in right paracolic gutter, pelvis, and around liver | CT abdomen-free fluid around liver and spleen and large haematoma in right abdomen and blood in lesser sac | |
|
| Operative detail | Laparotomy findings—1 litre of blood evacuated, extensive small bowel injury, multiple tears in mesentery, devascularisation of 200 cm of distal small bowel and devascularisation of midsigmoid colon with large mesenteric haematoma (Figures 1 and 2) | Laporotomy findings—800 mls of blood in lower abdomen and pelvis, devascularisation injury of terminal ileum and caecum | Laparotomy findings—4.5 Litres of blood in abdomen and pelvis, traumatic devascularisation of the terminal ileum mesentery |
| Operative procedure—resection of distal 200 cms of small bowel and caecum with side to side ileocolic anastamosis and Hartmann’s procedure | Operative procedure—modified right hemicolectomy with side to side ileocolic anastomosis | Operative procedure—small bowel resection and primary anastomosis |
|
| Outcome | Orthopaedic intervention day 10 postop:ORIF right periprosthetic femoral fracture, MUA right distal radius fracture MUA and K-wiring left distal radius fracture, 6 weeks non-weight bearing and physiotherapy | Lengthy postoperative ICU stay complicated by renal failure and sepsis | 24 hr ICU admission postoperatively, required transfusion 2 units RBC, uncomplicated postoperative course |
| Subsequent stoma reversal | Discharged from hospital day 60 postoperatively | Discharged day 7 postoperatively |
|
