1. Case report 8901021 楊佩真 Photograph @ July 2005 Italy by BUBU YANG

2. Patient profile GCS: E1V1M1 BP: 量不到 PR: 122/ 分 Endotracheal tube 7.5# 22cm 頸圈 chest tube left 32# –with continuous bleeding NG tube IV CVP 輸血

3. 氣管正中 (+) breath sound: R: clear – L: decreased circulation: none pupil 5.0/5.0 –non-reactive skin/ mucosa: pale, cold. dry bleeding from ear –active oozing from both ear –left > right with suspicious CSF leakage abdomen : mixed distended

6. 1418 arrive –on ventilation 7U 500 rate 16L –fiO2 100% –on EKG monitor –on pulse oximeter 1420 brain CT with enhanced fast no obvious fluid CT scan brain right SDH: middle shifting 1425 CVP 1433 chest tube left 32 號 fix 12cm total amount : 2300ml of blood Managements

7. 1445 BP 128/78 p 102 1445 N/S 1 BT 1445 adrenaline 1/2 amp 1450 N/S 1BT adrenaline 0.5U 1500 CPR 開始 1500 HR 無 adrenaline 1 amp CPR NahCO3 4amp calglon 1 amp N/S 1BT 1503~1506 adrenaline 1 amp gelofusine 1BT adrenaline 1BT N/S 1000 1BT 1510 adrenaline 1 amp 1513 HR 無 adrenaline 1 amp 1515 CPR machine \1550 CPR stop 1550 接 ventilation 離院

8. Image examination

15. Impression left massive hemothorax left multiple rid fracture left pneumothorax right SDH r/o skull base fracture.

16. Discussion Before arriving: – 小港 : –11am 車禍入小港 –Hypo-volemic Shock: On CVP(Right side) On endotracheal tube –X-ray  tension pneumothroax –On chest tube  hemothroax Drainage :1100 ml – 要求轉長庚  refused, except BP >100 – 輸血  in vain –CT scan  壞 轉高醫

17. Thanks for your attention! Photograph @ July 2005 Italy by BUBU YANG