Recently, the emergency department of City Children’s Hospital, received a case of young Ng. HTD, 27 months old, male, weighing 12 kg, living in Tan Phu, Ho Chi Minh City, was transferred from Xuyen A hospital with the diagnosis: hypovolemic shock, blunt abdominal trauma, broken pelvis, and femur. Taking a quick history recorded at 10am on the same day of admission, the father was driving a motorbike carrying the child, collided with another motorbike running in the opposite direction, the child fell onto the street, and was run over by a 2-ton truck running across the child’s right thigh. , was admitted to Xuyen A hospital, first aid was transferred to the City Children’s Hospital..Here, the child was lethargic, pale, pale, pale skin, pulse could not be caught, blood pressure could not be measured, and the blood pressure could not be measured. the hematocrit remained 17% (normal in this age group 32-37%), the doctors activated the red alert procedure, intubated to help with breathing, resuscitated for blood loss shock, CT scan of the brain, chest, Abdominal, pelvic X-ray, emergency extremities and direct transfer to the operating room within 15 minutes, with the presence of a full range of surgical teams in the specialties of general surgery, urology, neurosurgery, orthopedic trauma, thoracic surgery , the team of anesthesia and surgical resuscitation, imaging, recorded right femur fracture, left humerus fracture, right upper tibia open fracture, pelvic fracture, pubic bone, urethral injury, injury contusion of liver, spleen, pancreas, kidney, suspected urethral rupture, perineal tear 5x10cm, abrasion and abrasion of soft tissue skin on right abdomen, right thigh, should proceed to open bladder to skin, open colon splenic angle skin, pelvic immobilization, suture of vascular lesions in the femoral region, external fixation of the femur, tibia, cast splint to fix the left arm, ablation, suturing of perineal wounds, damage to the liver, spleen, and pancreas , the kidney is preserved. The volume of blood and blood products for transfusion was 750ml of erythrocytes, 200ml of fresh frozen plasma, and 3 units of platelet concentrate. Fortunately, the child had no intracranial lesions on imaging. After surgery, the child still had complicated progress, liver damage, although continued with increased liver enzymes, pancreatic enzymes, fever, was treated: mechanical ventilation, infusion of vasopressors, sedation, antibiotics, drugs to reduce secretion of gastric juice, infusion of albumin, N-acetyl cysteine for liver support, vitamin K1, transfusion of blood products, adjustment of acid-base and electrolytes. Care for perineal wounds with wound washing solutions and gauze As a result, after nearly 1 month of treatment, the child’s condition improved gradually, the child was weaned from the ventilator, was awake, able to eat and was discharged from the hospital for follow-up and rehab. by appointment to evaluate and reconstruct the urinary system including the ureters.
X-ray shows broken pelvis, pubic bone, femur, tibia, humerus
After surgery, sutured blood vessels to stop bleeding, sutured perineal wounds, fixed broken bones, opened the bladder to the skin, opened the anus temporarily, the child was transferred to the surgical resuscitation department for further treatment, and the nurse took care of the actual wound. difficult, very meticulous to avoid bacterial superinfection
After nearly a month of treatment, the child recovered gradually, was discharged from the hospital for follow-up follow-up examination by appointment to regenerate the urethra.
Doctor of CK2 Nguyen Minh Tien
City Children’s Hospital