Survival Fight of a Teen With Polytrauma, Severe Head Injury, Gr-V Liver Injury Followed By ARDS, Managed in a Rural Hospital of Andaman, India: Perseverance Gives Possibilities Even With Limited Resources

Survival Fight of a Teen With Polytrauma, Severe Head Injury, Gr-V Liver Injury Followed By ARDS, Managed in a Rural Hospital of Andaman, India: Perseverance Gives Possibilities Even With Limited Resources

Sidharth Bhasin (Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India), Anil Kumar Narayan (Andaman and Nicobar Institute of Medical Sciences, Port Blair, India) and Janardhan AL (Andaman and Nicobar Institute of Medical Sciences, Port Blair, India)
Copyright: © 2017 |Pages: 4
DOI: 10.4018/IJUDH.2017070104

Abstract

This article describes how the liver is one of the most commonly injured organs in the abdomen, especially in road traffic accidents. Patients do present with polytrauma and those who are hemodynamically unstable have a high morbidity and mortality, even in advanced hospital settings. Following is the case report of a 17-yr. old boy, who was involved in a road traffic accident with polytrauma, presented to a tertiary care hospital in a remote island, with Grade IV-V liver injury and developed ARDS in post-operative period. The patient was managed successfully and discharged.
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Case Report

17 years old boy presented with polytrauma resulting from a road traffic accident to the Government hospital in a rural and tribal area of Andaman & Nicobar. The patient was initially seen in the ward where he was bleeding profusely from the nose and oral cavity. On examination heart rate was 146/min, Non-invasive blood pressure was 76/46 mm Hg and GCS E2V2M3. Two 18 G iv cannula was secured, and normal saline was given, the airway was secured with Endotracheal tube (8.0 mm ID, cuffed, PVC). The patient was shifted to surgical ICU where all the standard monitoring was done, and the patient was reassessed by Anaesthesiologists and Surgeons. Given continuous bleeding and hemodynamic instability, it was decided to stabilise the patient and then to be taken for imaging. With a team of doctors including Ophthalmologist, Dental surgeon and Otorhinolaryngologist, patient's eye trauma, oral bleeding and nasal bleeding were primarily managed with packing ANS suturing, and once the patient became haemodynamically stable, he was taken up for CT scan on a ventilator.

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