Case Report

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Case Report

• by intern ???

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Patient profile

• Name ?X?
• Gender male
• Age 80 y/o
• Chart No.12885542
• Date 96.6.7 pm450

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Chief complain

• Fell down from height (3F?floor)
• 96.6/7 pm422

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Present Illness

• EMT, on collar
• Conscious clear ,E4V5M6
• Pale, cold sweating
• TPR 34.3, 98/min, 14/min
• BP168/127 mmHg
• Neck stiff, Chest pain, Abdomen discomfort

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Present Illness

• Right face abrasion, ecchymosis
• Right elbow open fracture (typeII)
• Right forearm abrasion (bleeding)
• Left wrist deformity (r/o close fracture)
• Right leg deformity
• (r/o femoral head fracture, pelvis fracture)

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(No Transcript)
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Past History

• BPH
• (suspect Prostate CA, PSAgt4, but free PSA/total
  PSAlt0.2 )
• HTN (-), DM (-), HBV (-), HCV(-)
• Glucose intolerance
• Cardiomegaly

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Management

• (1650)
• IV, O2, Monitor (SpO2 86)
• Tetanus Toxoid
• Blood examination
• (CPK306, Tropo-I0.21, CK-MB86.4)
• Ice packing
• Demeral
• Cefazolin Aq-dest (IV push)
• CXR (portable)
• Right, left wrist X-ray
• Right elbow X-ray
• L-spine X-ray

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• Right femoral X-ray
• Pelvis X-ray
• Brain facial bone CT
• L/R 1BT
• Wound care, splint use
• Check vital sign

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(No Transcript)
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• (1734)
• BP118/89 mmHg, pulse79,conscious change
• Dyspnea
• Circulationpale
• On endo with N/S 1BT
• Citosol, Genso, Adrenalin
• On CVC
• Arrange PRBC 4u
• ?? use

12

• (1745)
• BP77/52 mmHg, pulse132,
• Conscious not clear
• Circulation pale
• Gelofusine 2 BT
• L/R 2BT, N/S 1BT

13

• (1752)
• BP64/33mmHg, Pulse127
• Conscious not clear
• Circulation pale
• Gelofusine
• On foley
• (1800)
• BP48/26mmHg, pulse92
• Conscious not clear
• Circulation pale
• Adrenalin
• CPR
• Sign DNR

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• (1810)
• DC brain CT Abd CT
• DC all X-ray
• FAST echo (susp. pneumoportal)
• (1820)
• BP55/32mmHg, pulse110/min
• Conscious not clear
• Circulation pale
• PRBC2u

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• (1830) recheck BP, Pulse
• BP50/24mmHg, pulse 101
• Conscious not clear
• Circulation pale
• Arrange portable CXR
• (19--)
• BP not available, Pulse not available
• EKG standstill
• Expire at 1925

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• Right 1st rib frx
• Right 8th rib frx
• Left 7th rib frx

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Diagnosis

• Hypovolemic shock r/o retroperitoneal hemorrhage
• Right elbow open fracture
• Left wrist close fracture
• r/o Right femoral head fracture
• r/o pelvis fracture
• Chest contusion with rib fracture
• r/o ICH
• r/o pneumoportal

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Discussion
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Hepatic portal venous gas (HPVG)
(Pneumoportal)??????

• results from mesenteric vessels occlusion,
  leading to intestinal necrosis with a high
  mortality
• septic and hypovolemic shock, which was
  superimposed on intestinal
• distension and this resulted in intestinal
  hypoperfusion and submucosa damage.
• Use of imaging studies, HPVG is more frequently
  detected than before
• Diagnosis Echo, CT better than X-ray
• surgical intervention (necrosis, sepsis,
  peritonitis)
• aggressive supportive care, including antibiotics
  and fluid supplement