In 12.02.2018 at 02:45 a patient O.I., 1992 y/b., after RTA (road traffic accident) has admitted to ICU (Intensive Care Unit) of MC Erebouni in severe condition, conscious, with a chest pain, heavy breathing, with the diagnosis of polytrauma.
Radiologist of X-ray Department A. Gevorgyan carried out CT exam, which urgently allowed to reveal violation of the integrity of the internal organs, that helped the team of surgeons to develop the right tactics of staged surgical correction of injured organs and save the life of the patient diagnosed with: Combined thoracoabdominal trauma. Rib fracture in the right. Right apical pneumothorax. Pulmonary contusion. Fracture of middle third of body of sternum. Hemopericardium. Cardiac tamponade. Liver rupture. Internal bleeding. Hemoperitoneum.
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At 03:10 the patient was transferred to ICU (Intensive Care Unit). There he was intubated, and at 03:20 urgently was transferred to an operating room. Anesthesiological support of staged, multihour surgical intervention of the patient was carried out by anesthesiologist of Anesthesiology Department Dr. A. Cherqezyan.
Intraoperative consultation with Head of Thoracic Surgery Department Prof A. Hovhannisyan (MD) and Head of Cardiovascular Surgery Department V. Gasparyan MD, PhD. had been held.
Sternotomy and pericardiotomy were carried out by thoracic surgeon of General & Thoracic Surgery Department Dr. A. Martirosyan and cardiac surgeon of Cardiovascular Surgery Department Dr. A. Sevoyan (pericardial cavity was filled with ~ 1 l of fresh blood and blood clot). After its removal and inspection,the bleeding zone was found – rupture of the right atrial auricle with transition to the right atrium. Closure of rupture was carried out.The first stage of surgery was completed with mediastinal and the right pleural cavity drainage.
The second stage of the surgery: senior surgeon of General & Laparoscopic Surgery Department Dr T. Araqelyan and surgeon of the same department Dr S. Saharyan have performed laparotomy. During the examination of abdominal cavity 250 ml of blood was revealed, ruptures of diaphragmatic surface of the liver were closed. Drainage of the right subdiaphragmatic space and lateral spaces, as well as small pelvis on the right were carried out.
Proper organization of anesthesiological support in such complex staged surgeries is extremely important, as it enables the team of surgeons to accurately, clearly and calmly implement highly qualified surgical care.
The patient was again transferred to ICU, and stayed there for 3 days, then was transferred to Thoracic Surgery Department to continue treatment.
In 24.02.2018 the patient was discharged in satisfactory condition.The combination of injuries in the case described above (in particular, a trauma to the heart) is a complex and rare phenomenon in medical practice, and most often incompatible with vital signs. Timely provision of the first medical care, precise diagnostics, intensive therapy and multidisciplinary therapeutic approach, high professionalism and teamwork of the specialists of different profiles of MC Erebouni - and one more life has been saved!
