WTP4.14 Decision making saves lives in trauma. Seven surgeries in 34 hours: is this what trauma surgery is all about?

A 29-year-old male was dropped outside ED with alleged history of RTC.A homemade Tourniquet was applied at home to stop the bleeding during which time he collapsed became unresponsive. In rhesus, patient had no respiratory effort, no central pulse, GCS 3 with no signs of life. HOTT protocol started, intubated and bilateral chest thoracostomy done which revealed left pneumothorax. A large wound on the left proximal femur wrapped in clothes and two tourniquets (long shoelaces) soaked in bright red blood was noted. Despite intubation, bilateral thoracotomies and initiation of resuscitative measures no output was noted, so a decision for a clam shell taken which revealed an empty heart and a flat aorta with feeble heart contraction. Internal cardiac compressions started and manual compression on the thoracic aorta applied. Resuscitation continued and ROSC was achieved in 5 minutes. The chest cavity was packed and a PAN scan done which revealed abrupt cut off in the left SFA with absent distal flow. He was transferred to theatre for surgery with continuous resuscitation. He underwent 7 surgeries in the next 34 hours which included two thoracotomies, three laparotomies, an interposition graft and amputation. Developed severe ischemic liver injury with deranged LFT’s with coagulopathy which was managed conservatively. Had closure of amputation stump, VATS for empyema left side of chest and discharged after 53 days in hospital. Comments: Early recognition of injuries and management in trauma surgery is important and depends on injury patterns and physiological patient responses.