ABC: časopis urgentne medicine (Jan 2019)
Case report of penetrating thoracic trauma in road traffic accident
Abstract
Introduction: Thoracic trauma requires intensive care treatment since in many cases it could have fatal outcome due to heart, lungs or major blood vessels injuries. Typically chest and internal body organs injuries are caused by falling from significant high, could be seen in firearm or in cold weapon injuries due to penetrating mechanism, but most often are seen in motor vehicle accidents. The case report of severe thoracic trauma which was successfully resolved upon treatment received from prehospital and hospital teams. 54 year old female patient has been injured in a traffic accident, under unclear circumstances, when her car hit the wooden fence. The ambulance arrived on 24-Jun-2017 at 17:45 after they received a call for traffic accident in which a female driver experienced severe trauma. The patient was found stabbed by a large spear-like piece of wooden fence in her right chest. Initial physical exam revealed unconscious female patient with heavy bleeding from the chest wound. Her Glasgow Coma Score was checked as 3. Patient appeared pale and hypotensive with blood pressure of 98/50 mmHg, heart rate of 104/min, and O2 saturation of 90%. The ambulance team performed initial hemostasis and stabilized the foreign body. IV cannula was inserted and normal saline therapy was initiated. Laryngeal Mask Airway was inserted and cervical spine was manually stabilized and the patient was immediately transported to the hospital. At admission patient was unconscious, with heart rate of 70/min and O2 saturation of 70%. Large part of wooden fence 1.5m in length, with rectangle shape (10cmx4cm), was found stabbed in the frontal area of the right chest, penetrating the right breast and exiting at the area of the right armpit. The patient was intubated, thoracic tube/drainage was inserted and foreign body was extracted. Upon performed MSCT of the head, neck, chest and abdomen the additional removal of necrosed tissue and thromboendarterectomy with anastomosis of right axillary artery was performed. The patient was put on mechanical ventilation on the same day at 19:40. During the hospital stay many specialist consultations were performed. On 06-Jul2017 right chest tube was removed. On 12-Jul-2017 left chest tube was removed and percutaneous tracheostomy was performed. On 20-Jul-2017 wound plastic surgery was done. On 21-Jul-2017 the patient was removed from the ventilator. On 26-Jul-2017 Vacuum Assisted Closure therapy was applied. On 08-Aug-2017 Thiersch procedure was done. On 16-Aug-2017 plastic tracheal tube was change for metal tube, which was removed on 28-Aug-2017. During the hospital stay patient received multiple antibiotic therapy, antifungal treatment, gastroprotective therapy, anticoagulant therapy, analgesic treatment, bronchodilator therapy, antihypertensive therapy, cardiovascular therapy, antiepileptic therapy, vitamin supplements, hormone substitution, crystalloid and colloid solutions support, and blood and plasma transfusions. The patient was receiving enteral nutrition during the hospital stay. She was discharged home on 01-Sep-2017. Conclusion: Severe thoracic trauma represents life threatening condition which requires multidisciplinary approach, both on prehospital and hospital levels, especially intrahospital in order to preserve life.
