Polytrauma with Bone Fractures, Ruptured Spleen and Cardiac Tamponade: Case Report

Abstract

Background: The term “polytrauma” refers to multiple injuries that involve multiple organs or systems. The management of the patients who have suffered multiple injuries has been improving during the past century. We present a case of a patient who experienced polytrauma including bone fractures, ruptured spleen and cardiac tamponade. Case report: A 57 year old woman presented to the Emergency department after she experienced epilepsy attack and fell down the stairs. The patient has a history of epilepsy, mitral valve replacement and she has been taking warfarin for 16 years. She was in rehab after a traumatic subarachnoid hemorrhage with no neurological deficit. On admission to the regional hospital, woman was conscious (GCS 15/15), drowsy, experienced pain in the abdomen, legs, hands and face, but cardiovascular system and respiration were normal. Wounds on the right hand and femur were observed. X-ray showed right distal femur and right elbow dislocated and splintered, multiple foot, hand, jaw and pubis fractures. Free fluid in RUQ and Douglas pouch was observed during FAST. The patient was transferred to the Trauma center where additional observation revealed hemoptysis, BP 149/105, HR 111 bpm. Additional FAST showed that spleen might be ruptured and unidentified findings in the pericardial sac. Full-body CT scan revealed 1,1 cm of fluid around heart, ruptured spleen, hematoma in obturatorius muscle. The hemodynamics of the patient were deteriorating and the woman was taken to the operation room for splenectomy. Blood test results were INR 4,38, APTT 54 s, SPA 10% and tranexamic acid 1 mg was injected IV. After surgery patient was taken into the ICU and an immediate 2d echo revealed hyperkinetic LV, 3.8 cm fluid by RA - cardiac tamponade. A cardiac surgeon performed US-guided drainage of 250 ml and patient’s hemodynamics were quickly improved. Overall 4 units of RBC were transfused and angioembolization of arteria obturatoria was performed. The next day the patient’s femur was externally fixated. The patient remained stable during hospitalization. Conclusions: Early and adequate treatment of severely injured patients can only be successful if its management starts at the beginning of the accident. The trauma team should be prepared to manage severe injuries and follow standardized guidelines to detect and correct changes that can be life-threatening.