Recently, City Children’s Hospital received a case of VT KH. 7 years old, male, living in Dong Thap. Exploiting the medical history recorded on the same day of admission, the child went to the construction site to play with his hand in the concrete mixer, stuck his hand in the machine, the worker discovered that the machine was turned off, took the child out and found that his arm was crushed. (T), was taken to a local hospital by family members, given first aid with splints and analgesia, transferred to City Children’s Hospital. Here, the child was lethargic, pale skin, pale lips, Pulsed pulse on the right hand side was mild, blood pressure was 80/60mmHg, heart and lungs were rough, abdomen was soft, wound on left arm was crushed, bleeding, no catch the spinning circuit. Check erythrocyte Hct to 18%. Diagnosing a crushed left hand wound that causes brachial artery rupture, bleeding, hemorrhagic shock, immediately emergency doctors activate the red alarm process, at the same time force the wound to stop bleeding, intubate help with breathing, set up 2 intravenous lines of anti-shock fluids, register blood, transfer to the operating room within 15 minutes. Team of orthopedic doctors, vascular, surgery, anesthesiologists, surgical resuscitation, blood banks, actively resuscitating fluids, blood transfusions, administering vasopressors, correcting blood metabolic acidosis. The doctors performed: Excision, exploration of crushed wounds from the arm to the hand (T), a lot of necrotic tissue, a lot of sand and soil, and a lot of sandy soil. Examine for rupture and contusion of a segment of brachial artery (T) 15 cm.
Realizing that the artery could not be cut, the doctors made a 10cm skin incision, at the ankle (P) took a 12cm segment of saphenous vein, Irrigated with Heparin, rotated the tip of the saphenous vein graft to replace the wing artery. The hand is amputated, Suture the muscle covering the bone, Amputate the 1st and 3rd fingers (T): because of poor perfusion, the risk of infection is high. After vascular surgery, the child continued to be treated at the surgical resuscitation department, provided respiratory support, antibiotics, used high-dose anticoagulant Heparin, cared for the wound through ablation, placed VAC irrigation, and suctioned pressure. Continuous negative force and biological gauze to disinfect, absorb dead tissue, stimulate growth of granulomatous tissue.
After nearly 2 months of treatment, the blood vessels have good circulation, and the perfusion of the extremities is ruddy. The child was weaned from the ventilator, was awake, had a skin graft, and gradually recovered his left arm, able to move up and down as usual.
Through this case, we draw attention to parents to educate their children to be aware of the dangers lurking when they come to play at construction sites such as entering unfinished excavations flooded by rainwater, tools. Walls and walls, scaffolding can collapse, brick cutters, concrete mixers, etc. are very dangerous to life.
Doctor 2 Nguyen Minh Tien
City Children’s Hospital