VCU DEATH AND COMPLICATIONS CONFERENCE

Introduction of Case  Complication Death  Procedure  Ex. Lap, Splenectomy, Left anterior thoracotomy, Ligation of bleeding intercostal vessels and Apthera Wound Vac Placement  Primary Diagnosis  MVC with Blunt Trauma to thoracoabdominal region, Cardiac Arrest, Positive Fast Exam with hypotension

Clinical History  66 y/o male was a delta trauma alert after being involved in a motorcycle versus truck accident. Pt skidded off his motorcycle and was run over by the truck. He was initially responsive in the field, then noted to be unresponsive in transport.  PMH:HTN, diabetes, CAD, obesity (BMI 43)  PSURG: CABG  FH: DM, HTN, CAD  MEDS:ASA, Plavix  SH:Unknown

Clinical History  The patient arrived in the emergency room with a GCS of 3 and pulseless  CPR minutes and intubated  Bilaterally CT tubes  Vitals- T-99 HR- 144 BP-80/60  NEURO-Pupils were fixed and dilated  RESP- CTA B, no crepitus, large chest wall abrasions  ABD- obese, soft distended  PELVIS- stable  Extremities- no signs of trauma  FAST-positive  LABS: Lac >20, Bun/Cr 30/ 1.9, Hbg-9, Plt 69, INR-1.8, PTT >150.

OR  Findings:  Rupture spleen  1.2 L out of Left chest tube  Left anterior thoracotomy  Multiple Rib Fx and bleeding intercostals vessels  ABG- 6.80/64/180/10  Lac >20  LABS: INR 5.8, Plt 40 and Fibrinogen 66  12 units of RBCs, 14 of FFP, 12 of platelets, 30 units of cryo  Requiring epinephrine, norepinephrine, and vasopressin

Analysis of Complication Was the complication potentially avoidable? NO Would avoiding the complication change the outcome for the patient? N/A What factors contributed the complication? Significant Blunt Trauma Injuries, Co morbidities

Teaching Points  Critically injured patients must receive high-quality care from the earliest post injury moment to have the best chance of survival  Mortality is increased in septic or severely injured patients with DIC  Intraoperative Indications to Perform Damage Control Operations - Initial acid-base status( ph, Base deficit, Serum lactate), Onset of coagulopathy, temp, etc.,  Emergency Department Thoracotomy is done for blunt trauma; 2% survival in patients in shock and less than 1% survival with no vital signs.