2. HISTORY
Patient was brought by JPAM to ED Hospital Sungai Bakap on 24/2/2021 @ 2014
HRS
Complaint of alleged MVA (MB vs Car) today around 1940 HRS, patient was
motorbike rider, helmet (+).
Sustained bilateral upper limb deformity with laceration wound over bilateral
hand and laceration wound at upper lips.
No LOC, No RA, No SOB, No chest pain, No abdominal pain, No nausea and No
vomiting.
4. Physical Examination
Chest spring : negative
Pelvic Spring : negative
Lungs: Clear, equal air entry
CVS: DRNM
Abdomen: Soft, non tender, no guarding, fast scan x 1 no free fluid seen
Log Roll: No deformity seen, no cervical and spine tenderness
5. Local examination at Right upper limbs (arm and forearm)
Deformity (deform arm and forearm)
Tender on palpation
Neurovascular intact
No obvious wound seen
Local examination at Left upper limbs (arm and forearm)
Deformity (deform arm and forearm)
Tender on palpation
Neurovascular intact
No obvious wound seen
Noted laceration wound size (1cm x 2cm) at 5th finger of left hand and laceration wound size
(2cm x 2cm) at 2nd finger of right hand. No active bleeding
Noted Laceration wound size (2cm x 2cm) at upper lips. No active bleeding
6. Plan
IVD 1 pint normal saline over 1 hour
IV Fentanyl 25 mcg stat
IM voltaren 75 mg stat
Blood ix – FBC, RP, LFT, COAG profile
Xray – CXR, Pelvic, Cervical, Bilateral Humerus, radius, hand
Put on splint over both arm and forearm
Keep cervical collar until review Xray
Current imp: Polytrauma Tro #
7. Case Progress
Patient was transfer to xray department at 2120 HRS
At 2140 HRS, received called from X-ray department, informed that patient
was restless and not obeying command.
Attend stat to Xray department
Noted patient was restless, GCS E4, V2, M5, pupil bilateral 3mm sluggish
Lungs: Clear, equal air entry
Plan: T/o patient to red zone stat and prepare red zone for intubation and
further management.
8. Case Progress
Patient was intubated at 2145 HRS in view of patient was poor GCS and for
cerebral protection.
Patient was intubated using ETT size 7.5, anchored at 22, attempt x 1
Pre medication
IV Fentanyl 100 mcg
IV Midazolam 50mg
IV scholine 100 mg
Sedation – IVI midamorphine 3cc/h
9. BP post intubation : Unrecordable
HR: 140x/m
Spo2: 100% (intubated)
Repeated fast scan – noted free fluid at right hypochondriac region
Plan
To transfuse 2 pint safe o stat
To get new IV line (only have one pink branula at left foot)
Difficult line. Attempt x 5
To get Intraosseous access (after discuss with EP oncall) – inserted at right proximal tibia
using IO needle size 25mm
IV traxenamic acid 1g stat
10. At 2215 HRS, noted at cardiac monitor PEA and Asystole
CPR commenced stat as per protocol
2 pint Safe O was transfused as planned
CPR patient for 1 hour
IV adrenaline 1mg given x 15
NO ROSC
Patient was pronounced death at 2315 hrs
Imp : DID post MVA pending post mortem
12. Post mortem finding
Noted 2nd and 3rd right rib #
Noted 3th – 6th left rib #
Sternum #
Right lung: noted 150cc blood
Left lung: noted 50 cc blood
Heart : Noted punctured wound at left ventricle 2.5cm x 0.5 cm
Aorta: Noted ruptured abdominal aorta (20cm x 3cm)
