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e-CASES: Polytrauma due to road traffic accident, motorbike collided with light vehicle, front impact with no helmet

33-year old patient, road traffic accident, motorbike collided with light vehicle, front impact with no helmet.

 

At the arrival of the Fire department: coma, Glasgow = 3, bilateral mydriasis, gasp, emergency intubation, state of shock with blood pressure of 64/40, pulse: 140, not possible to measure saturation.
Induction and intubation. Lesions observed: open left tibia-fibular fracture, displaced closed fracture of the left wrist, reduced on site, possible fracture of the left femur, hemoptoic bronchial aspirations, exposure of external genitalia.

 

On arrival at the university hospital:
. no abdominal guarding or contracture,
. no thoracic deformation but decrease in right basal breath sounds,
. no pelvic instability,
. neurological aspects: symmetric intermediate pupils, significant facial wounds with bleeding: right superciliary arch, submental wound, auricle, earlobe and lips,
. hemodynamic aspects: heart rate = 80, blood pressure = 95/30 after intravenous fluid therapy with 2 liters of colloids, peripheral pulses detected in upper and right lower extremities but absent in left lower extremity, left foot cold, skin capillary refill time more than 3 seconds. Temperature 33.7°C, peripheral O2 saturation 100% under high oxygen concentration, exposure of external genitalia.

 

The body scan is provided with an angiography scan of the lower extremities given the suspicion of an arterial wound.