Findings of exploratory laparotomy Case Presentation• Splenic injury ….grade 5• Renal injury…….grade 4• Lt colon crushed• Abdominal cavity full ofblood• Retroperitonealhematoma
Definitive surgical treatmentFindings of exploratory laparotomy Case Presentation• Splenetomy• Nephrectomy Lt• Sigmoid Colostomy
Post op recovery management • Mechanicl vent for 2 days • Drain output gradually reduced • Pneumovac given • Patient went into DIC with deranged PT & APTT • FFPs and platelets transfused • 7 blood transfusions done gradually • Stoma started working on 2nd POD
Cont….. management• Patient gradually reovered• Urine output remained satistory• Wound….healthy• Stitches out on 11th POD• Patient discharged home on 13th POD
DiagnosisManagement of polytrauma patients Resuscitation & definitive management
How good is FAST? FAST• As a decision making tool for identifying the need for laparotomy in hypotensive patients (Systolic BP < 90), FAST has:• a sensitivity of 92%,• specificity of 96%• Accuracy 93%• How good is FAST?