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Saving the life of a 1.5-month-old child whose arm was crushed by a sewing machine, damaged blood vessels and nearly amputated

Recently, at City Children’s Hospital, a young case of V. NG. KH 1.5 months old, female, living in Ben Tre was transferred from Nguyen Dinh Chieu hospital with diagnosis of Elbow injury (T) – TD injury to left brachial artery (T) – Closed fracture of the lower humerus. The medical history recorded 4 hours before admission, the child was lying in a hammock when the sewing machine fell on his arm (T), the baby cried, the family took the child to the local hospital for first aid and then transferred to the City Children’s Hospital .

Here recorded pale lips, lethargy, pulse pulse (T) is difficult to catch, Sp02 is difficult to measure, arm (T): deformity, limited movement, large bruise from elbow area spreading to forearm (T) ), the skin is cold, the fingers are almost motionless. Hand vascular ultrasound (T): blood vessels in the left forearm and elbow did not show arterial signal, noted a large hematoma in the medial area of ​​the left elbow. Children were given oxygen, intravenous fluids, blood transfusion, consulted orthopedic specialists to decide on emergency surgery, purple fingers before surgery, radial pulse could not be caught, skin incision, fracture repair, blood vessel removal from fracture, results. 2 condylar fractures. Exploration revealed brachial artery contusion to the elbow division, dissection to remove the forearm hematoma, red finger tip, CRT < 2 s, sparse skin suture, cast splint. After surgery, the child was transferred to the surgical resuscitation department, the child was lying still / sedated, the vital signs were stable, after 6 hours of follow-up, cyanosis appeared from the elbow (T) to the forearm (T), no pulse was detected. Rotation (T), cool extremity, unmeasurable SpO2, poor finger movement, ultrasound of brachial artery (T) inferior and 2 forearm arteries (T) no DOPPLER signal and team consultation Angioplasty performed angiography, noted that the axillary artery was completely blocked at the injury site. Drive the guirewire through the stenosis and completely open the axillary artery, showing limited flow, narrow blood vessel, d = 1.5 mm , drive through the narrowing area down to palmar angioplasty à Checkup after angioplasty shows good revascularization to the finger. The pulse on the back of the hand is clear and the hand is ruddy, the spO2 is 98% clear. Children continued to receive otolaryngology, surgical resuscitation, mechanical ventilation, anticoagulation with heparin combined with enoxaparine, analgesia, antibiotics, and nutrition. Ultrasound after revascularization: brachial artery, radial artery, left brachial artery flow (+). However, 2 days later, the child showed signs of swelling of the forearm (T), weak radial pulse, crying on palpation, poor skin perfusion, suggesting forearm compartment syndrome should be consulted by a doctor. orthopedic decompression incision. Results after more than 2 weeks of treatment, the child's condition gradually improved forearm (T) less swelling, good perfusion, ruddy skin, clear radial pulse, weaned breathing, good feeding.

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When the baby’s condition was critical and stable, we investigated the circumstances of the accident and was told by the stepmother that the mother is a mechanic, the house has 2 sewing machines, the mother hangs a hammock on one end to nail the wall on the other end. Tied to the machine because I think that the baby’s low weight will not affect anything. Unfortunately, while the mother went down to the baby’s house to get water mixed with milk for the baby to drink, the two sisters, 4 years old and 6 years old, kissed the baby and pressed the hammock, causing the sewing machine to tilt, about to fall, leaving the baby to run away, the sewing machine continued. fell on the baby’s hand and crushed it… fortunately, it didn’t hit the child’s head or body, causing brain or visceral injury. Therefore, we note that parents should not be subjective in doing anything that is at risk for their children. We need to consider…very carefully…The house for children must be a “safe house”…

The left forearm that was thought to be amputated was vascularized, decompressed the cavity, mixed with anticoagulants, restored skin grafts
The left forearm that was thought to be amputated was vascularized, decompressed the cavity, mixed with anticoagulants, restored skin grafts

After more than 2 weeks of treatment, the child's condition gradually improved forearm (T) with less swelling, good perfusion, rosy skin, clear radial pulse, weaned breathing, good feeding.
After more than 2 weeks of treatment, the child’s condition gradually improved forearm (T) with less swelling, good perfusion, rosy skin, clear radial pulse, weaned breathing, good feeding.

Doctor 2 Nguyen Minh Tien
City Children’s Hospital


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