Doing Less is Better: Challenges in Complex Polytrauma Management - Case Report
- Author:
Farah NA
1
;
Johar MJ
;
Ismail MS
Author Information
1. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
- Publication Type:Case report
- Keywords:
Acute;
Damage Control Resuscitation;
injury;
kidney;
Permissive Hypotension;
Polytrauma;
Rhabdomyolysis
- From:Medicine and Health
2018;13(1):251-258
- CountryMalaysia
- Language:English
-
Abstract:
Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemic-reperfusion injury and acute kidney injury. We present a case involving a 20-year-old man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed.
