AASDV

1. General surgery department -PMC

2. History of present illness
 27 years old Patient presented on 15/08/2023 to ER
complaining of Right chest pain and shortness of breath,
after penetrating trauma by metallic object to the right
side of the neck zone I
 incidence was 6 hours prior to arrival to ER
 Past medical and surgical history were free

3. Physical exam
 patient was conscious
 Vital signs : HR: 105 , sat o2 95%, BP 92/55
 decrease air entry upon auscultation at right side
 otherwise, normal findings

4.  Chest CT Scan : Right Side Hemothorax
 Chest Tube Was Applied In Er :
 Gush Of 1200cc Blood and tube was Clamped

6.  Patient was admitted to ICU , kept npo
 Started in IV fluid 2500, Rocephin 1g*2, perfalagan
1g*3, nexium 40mg*1, pethidine 50mg*2
 On close monetoring for urine output and vital signs
 On Serial HGB

7.  ON DAILY BASIS THERE WAS DECREASE IN CHEST
TUBE OUTPUT
 DISCHARGE WAS SEROSANGUINOUS
 800 TO 300 TO NILL ON 19-8-2023
 THERE WAS NO DROP IN HGB UPON SERIAL CBC
 SO PATIENT TRANSFERED TO WARD ON 20-8-2023
AND DISCHARGED ON 22-8-2023

8.  AFTTER ONE WEEK PATIENT RETURNED TO OPC
COMPLAINING FROM SAME SYMTOPMS
 CHEST CT SCAN WAS DONE : SHOWED RIGHT
SIDED HEMOTHORAX
 PATIENT ADMITTED FOR THORACOCENTESIS,
ROCHEPIN 1G*2 AND PERFALGAN 1G IV PRN WERE
GIVEN

9.  ON 27-9-2023
 PATIENT WAS DOING WELL, KEPT IN SEMI
SITTING POSITION AND GENERAL DIET AS
TOLERATED
 UNDER LOCAL ANESTHESIA CENTRAL LINE
INSERTED INTO RIGHT PLEURAL SPACE WITH
DRAINAGE OF BLOODY FLUID & KEPT ON FREE
DRAINAGE

10.  FOLLOW UP ON 17-10-2023
 ON CXR THERE WAS MINIMAL RIGHT SIDED
HEMOTHORAX

11.  ON 28-8-2023
 DRAIN : 100cc BLOOD
 ON 5-9-2023
 CENTRAL THORACIC LINE REMOVED AND
PATIENT DISCHARGE IN STABLE CONDITION

12. Case Discussion

13. Neck Anatomy
 For descriptive and clinical management purposes, the
neck is divided into three zones: zones 1, 2, and 3.

28. Take home massage
 Since physical examination may not be reliable in ruling
out injuries in patients with neck trauma, one should
consider a low threshold for obtaining additional imaging
studies and/or surgical consultation.
 Periodic examination is required to identify deterioration
in clinical status.
 Obtain anterior and lateral neck and chest radiographs in
any patient presenting with significant neck trauma and
look for hemothorax, pneumothorax, or
pneumomediastinum. These should be obtained especially
for patients with zone 1