Recently, City Children’s Hospital saved the life of a serious multi-drug case by applying the red alert process. It is a 13-year-old MTH child, male, living in Binh Chanh, HCMC. History: At 11:30 a.m. on the same day of admission, a child who went to school on an electric bicycle with a helmet was hit by a truck, the mechanism of injury is unknown, was admitted to the City Children’s Hospital in a state of lethargy, pale skin , SpO2 84%, light pulse 120 l/min cold extremities, blood pressure 70/50 mmHg, broken left 7th rib arch, distended abdomen, 14% Hct (normally at this age, Hct 38-45%).
Management of intubation to help breathing, establishment of 2 intravenous lines, anti-shock fluid infusion, emergency blood registration, activation of the red-alert procedure including general surgery, thoracic surgery, anesthesia and resuscitation , diagnostic imaging, surgical resuscitation, blood bank, transfer the child to CT scan of the brain, chest and abdomen, to the operating room within 15 minutes, record damage through imaging, abdominal ultrasound: splenic contusion, focal fluid large amount of blood think. Abdominal CT scan: liver: left hepatic parenchyma tear separates segment II, III, subcapsular hematoma, intact portal vein, perfused liver segments, spleen: broken spleen blood supply to the splenic parenchyma, no thrombosis of the splenic vein, unbroken splenic artery, with an irregular #12 mm artery segment, monitoring for arterial rupture, left kidney: left subcapsular hematoma, no Renal parenchymal tear was clearly noted, large amount of abdominal fluid, high density fluid, no pancreatic injury was noted. Chest X-ray: alveolar consolidation, bilateral diffuse near-opaque opacity, monitoring for pulmonary contusion/bleeding, left 7th rib arch fracture, 8.9 left lateral arch fracture, left hemothorax, subcutaneous pneumothorax chest wall in this area. CT Scan of the chest: pulmonary contusion with hemorrhage in the left apex and the entire lower lobe of the left lung, left hemothorax. CT scan of the brain: hemorrhagic nodules (<3 mm) scattered in the brain parenchyma on both sides. Hemorrhage in the left ventricle and hematoma under the crescent of the cerebrum. Diagnosis: Hemorrhagic shock/Spleen injury grade IV, liver injury grade IV, Pulmonary contusion, hemorrhagic lung, left rib fracture, 7,8,9 left ribs, Brain hemorrhage/ Traffic accident at 1st hour. The child underwent emergency surgery. acutely recorded in the abdomen, a lot of dark red blood and blood clots poured out into the abdomen, sucked and removed the active clot from the abdomen, inserted gauze on the bleeding sites, recorded the lesions: 1/ 2 upper poles of the spleen broken, 1/2 lower pole of the spleen is still pink, there is a double splenic fissure, the splenic artery bundle is not broken but there is a partial contusion of the transverse blood vessel on the tail of the pancreas, bleeding profusely in this area , the gastric artery is short, the gastrosplenic ligaments, the splenic and splenic ligaments are bleeding oozing, contusion of segment II-III liver, no tear line or cortical hematoma, hematoma. blood around the left renal capsule, the thickness of the hematoma is thin, the capsule is intact, the left diaphragm is crushed, the hematoma is in the left posterior peritoneal wall and the fascia told of the descending colon, the amount of blood sucked from the abdomen is about 2000ml. Carry out hemostasis, expose the splenic stalk, control blood vessels and splenic stalk by suturing with vicryl 3.0 thread, release the gastrosplenic, renal, and diaphragmatic ligaments, and remove the entire spleen from the surrounding tissue. , splenectomy. Check the hemostasis carefully, wash the abdomen, remove the abdominal fluid. Insert a piece of surgicel into the splenic fossa to stop bleeding. Insert a 20 Fr drain into the splenic space, place a left pleural drain to drain 500 ml of blood. Children received 2500ml of blood, 900ml of fresh frozen plasma, 8 units of platelets. The child was transferred to the ICU for further treatment with intravenous fluids such as antibiotics, hemostatic drugs, analgesics, liver support therapy, vitamin K1, N acetyl cysteine, intravenous infusion (due to severe liver damage AST/liver enzymes). ALT is elevated above 2000 units/L), against cerebral edema. Results after nearly 1 month of treatment, the child's condition improved gradually, the pleural and peritoneal drainage tubes were withdrawn, the ventilator was weaned, he was breathing air, and he was awake.
Doctor 2 Nguyen Minh Tien
City Children’s Hospital