Polytrauma

Brief hx taking
Patients detail

CHIEF COMPLAINT:

Multiple injuries and

pain for 3 days
following MVA

Name: X
Age:25y/o
Gender: female
Occupation:Housewife
Date of
admission:20.11.16

HOPI

Pt had NKMI. She is well until 3days ago she was involved in
MVA. She was riding her motorcycle with her son(1y/o),and her
aunt. She wore helmet, ride at a speed 50km/h when a car in
front of her suddenly made a turn. Even though she immediately
brake, she still hit on the back of car and was thrown out. She
immediately pass out as she landed on ground. Upon admission
to hospital, she regain her consciousness. She can't recall any
details such as any crackling sound hear, any bone seen or
bleeding at the injury site and how long she faint.

She claimed there are 5 painful sites which is her left lower
limb, pelvic region, abdominal pain, bilateral kidney
injuries, and her right upper limb.

The pain is sudden onset, severe continuous stabbing pain

without radiation. Pain is aggravated with movement and
relieved by rest, associated with numbness and swelling. Pain
score given 9/10.

Alleged MVA sustained:

1. Displaced comminuted # proximal 1/3 of L
femur
2. Closed displaced comminuted # distal end
of right radius
3. Multiple pelvic bone #
4. Displaced # R superior & inferior pubic rami
5. Comminuted # left acetabulum
6. ?# left maxillary bone

 Examination in ED by ortho team

1. Rt hand exam:
-Noted swelling,redness,and mildly
inflammed
-Bruises at Lt knee & Rt arm
-CRT immediate
-Distal pulses palpable
-Limited ROM of finger due to
painsuperficial abrassion of fingers

Lt LL exam

PR exam

-Swelling on mid thigh

-Limited ROM due to pain
-Sensation intact
-DPA, PTA palpable

Perianal sensation intact

BCR present
Anal tone intact

LOG roll:
- No cervical tenderness
- No spinal tenderness
- No step deformity

Multiple abrassion:
-Rt iliac fossa
-epigastric region
-Lateral Lf knee

Progress
Initially admit to 1cd for cerebral concussion
then transfer to 4cd in view of no active Mx
from neurosurgical currently.
CMR for Rt upper limb done in 1 cd and put
on FLBS
Xray post CMR done to be review by
specialist
Had episode of lowish BP in 1cd bfr transfer
BP- 96/58 resus with 1 pint NS 118/70
but persistent tachycardic

Currently

On npO2,no SOB/chest pain

Had episode of fever ,currently NO
Pain tolerable
+ numbness over Rt hand

Currently
Rt UL exam:
- On FLBS ( bandahe
removed)
- Minimal movement
over fingers due to
pain
- Sensation intact
- CRT immediate
- Numbness over Rt
hand

Lf LL exam:

On skin traction with

thomas splint
Sensation intact
Crt immediate
Able to move toes

 Implant:
- Long volar angle locking plate right
radius
- Interlocking nail Lf
femur(Reamed/Unreamed size 9)