kushiya prep.pptx for medical emergency students
- 2. Brief History Patient brought to ER on 04/06/2024 @ 1:54 pm with alleged h/o RTA Three wheeler (Auto) hit against the wall near ChittiKadu and sustained injury to the multiple regions
- 3. Secondary Survey S - A Not Known M -Not Known P - Not Known L - Not Known E - Not Known
- 4. General Examination Intubated ,Sedated and ventilated No pallor, icterus, clubbing,cyanosis, Pedal Edema, Lymphadenopatty CVS:S1S2(+),No murmur RS:BAE(+) decreased over the left P/A: Soft, BS(+) CNS: Pupils unequal reacting to light GCS:2T/15
- 5. Systemic Examination HEAD ,Neck and MAXILLOFACIAL Abrasion over the left side of the cheek Laceration in the supraorbital region size: 4x2 cm Laceration in the right upper lip (2x1x1cm) Philtrum abrasion (+) CHEST Bilateral chest wall movements (+) use of accessory respiratory muscles (+) No Tracheal deviation No deformity, swelling, subcutaneous emphysema , open/blunt injury Decrease air entry noted over left side No added sounds Dullness noted over the left side INTERVENTION Airway secured ,continued ventilation and sedation GCS:2T/15 pupils reacting to the light 1.5 mm right eye and 2 mm left eye Maintain adequate in-line immobilization and protection of the cervical spine Wound care management done For laceration suturing done Xray left side white out lung PLAN -CT imaging
- 6. ABDOMEN AND PELVIS No signs of blunt and penetrating injury and internal bleeding. bowel sounds (+) On compressing ,Pelvis Tenderness not elicited PERINEUM/RECTUM/VAGINA No Contusions and hematomas,Lacerations ,Urethral bleeding No Rectal blood B. Anal sphincter tone- normal No blood in vaginal vault Efast - negative No extraperitoneal bleed X ray pelvis taken bedside no obvious injury found NIL
- 7. Adjunts to the Secondary survey Spinal X-rays CT Brain, PNS
- 8. Diagnosis RTA/SEVERE HEAD INJURY/DIFFUSE AXON INJURY/LATERAL WALL OF ORBITAL FRACTURE/LATERAL WALL OFMAXILLARY BONE FRACTURE
- 9. Treatment in ER Intubated, sedated , ventilated Prop up position 15 degree INJ TETANUS TOXOID INJ LEVIPIL 1 G IV STAT INJ PANTOPRAZOLE 40M G IV STAT INJ EMESET 4MG IV STAT INJ XONE 1 G IV STAT INJ METROGYL 500 MG IV STAT INJ TRAPIC 1 G IV STAT
- 10. Speciality opinion NEUROSURGERY ORTHOPEDICS GENERAL SUGERY
- 11. Neurosurgery advised ICU Admission Plan Emergency thoracotomy Kindly collect the pending lab reports Explained to the attenders in an understable language Orthopedician requested for CT Pelvis fracture General surgery Nil intervention Patient attenders not willing for futher management Discharge against medical advice