Activate the red alert process to save the lives of children with severe trauma

Recently, the emergency department of City Children’s Hospital, received a case of C. Th. Ph., 4 years old, male, weighing 16 kg, living in Long An, was transferred from Long An Obstetrics and Children’s Hospital with the diagnosis: hypovolemic shock, blunt abdominal trauma, operated ventricular septal defect. Taking a quick history recorded at 13:30 on the same day of admission, the mother drove a scooter carrying the child, hit the board, then the board hit the child’s abdomen, after the collision, the child had abdominal pain, dull, purple, entered Long An Obstetrics and Gynecology Hospital in a state of depression, cyanosis, SpO2 65%, pulse can’t be caught, blood pressure is difficult to measure, abdominal pain, distention, treated with endotracheal intubation, anti-shock fluid, blood transfusion (500ml) , vasoactive Adrenalin, Noradrenalin, transferred to City Children’s Hospital.. Here the doctors activated the red alarm process, resuscitated blood loss shock, CT scan brain, chest, abdomen urgently and transferred directly to operating room within 15 minutes, full presence of surgical crews of general surgery, urology, neurosurgery, orthopedic, thoracic, anesthetic and surgical resuscitation team, imaging Performing exploratory laparotomy, the abdomen was filled with blood clots and fresh blood: about 500ml was aspirated in children with nearly severed segment V and part of segment VI, left portal vein branch (right at the site of internal liver rupture). segment V) 2 places tear, 4mm-5mm in diameter, bleeding and tearing right hepatic duct in 2 places, about 2mm and 1mm in diameter, splenic injury in middle 1/3 and right upper pole infarction, lung contusion , bilateral hemothorax, segment V and 1 segment VI of the liver were removed, including the gallbladder, hemostasis in sectional area, sutured portal vein and right hepatic duct, placed bilateral hemothorax drainage , pancreatic injury, kidney is preserved. The volume of blood and blood products for transfusion was 1250ml of erythrocyte sedimentation, 300ml of fresh frozen plasma, and 4 units of platelet concentrate. Fortunately, the child did not have intracranial lesions, or fractures on imaging. fever, okaytreatment: mechanical ventilation, infusion of vasopressors, sedation, antibiotics, infusion of albumin, N-acetyl cysteine ​​for liver support, vitamin K1, transfusion of blood products, correction of acid-base and electrolytes. Results after more than 1.5 months of treatment, the child’s condition improved gradually, the child was weaned from the ventilator, removed all the pleural and abdominal drainage tubes, was awake, able to eat and was discharged from the hospital for follow-up and follow-up examination. appointment.

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Chest X-ray showed the child had collapsed lung and hemothorax
Chest X-ray showed the child had collapsed lung and hemothorax
After lobectomy to stop bleeding, suture the tears in the portal vein, hepatic duct, the child was transferred to the outpatient resuscitation department for further treatment.
After lobectomy to stop bleeding, suture the tears in the portal vein, hepatic duct, the child was transferred to the outpatient resuscitation department for further treatment.
After more than 1.5 months of treatment, the child recovered completely and was discharged from the hospital for follow-up follow-up appointments
After more than 1.5 months of treatment, the child recovered completely and was discharged from the hospital for follow-up follow-up appointments

Doctor of CK2 NGUYEN MINH TIEN
CITY CHILDREN’S HOSPITAL

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