SEVERE THORACIC TRAUMA (STT) ASSOCIATED WITH COMPLETE GLENUMMERAL LUXATION WITH HUMERUS EXPOSURE IN A POLYTRAUMATED PATIENT: CASE REPORT

• DOI: 10.22533/at.ed.1593382330055

• Palavras-chave: Polytraumatized; Severe Thoracic Trauma; Unstable Chest and Exposed Dislocation.

• Keywords: Polytraumatized; Severe Thoracic Trauma; Unstable Chest and Exposed Dislocation.

• Abstract:

  Severe Thoracic Trauma (STT) in a polytraumatized patient indicates greater morbidity and mortality, with complications such as hemorrhage, shock, sepsis, multiple organ failure and respiratory failure. The severity of this trauma depends on anatomical factors such as the number of fractured ribs, the presence of bilateral fractures, flail chest and pulmonary contusion, being determinant for patient management. This report is about a case of a TTS caused by a motorcycle accident followed by being run over that showed signs of hemodynamic instability and shock, in addition to a reduction in bilateral breath sounds, chest pain and pain in the RUL, with exteriorization of the head of the right humerus being observed in the admission, without external signs of flail chest. The patient was stabilized with volume replacement and transfusion protocol with blood components and referred for Computed Tomography (CT). However, the patient was hemodynamically unstable and hypoxemic, which required sedoanalgesia for orotracheal intubation and support with mechanical ventilation before going to the Surgical Center of the unit. Subsequently, she underwent splenectomy, due to grade IV contusions-lacerations in the spleen, and water-seal thoracic drainage bilaterally, due to the presence of hemopneumothorax on the left and pneumothorax on the right. In addition to mechanical-surgical cleaning with open reduction of exposed dislocation of the right humerus. After the surgical procedure, the patient was transferred to the Intensive Care Unit (ICU), where she remained sedated during the postoperative period, under Mechanical Ventilation for 14 days and hemodynamically stable. In the subsequent 24 days in the ICU, the patient was receiving analgesics optimization to control pain, antibiotic therapy to control infections and respiratory and motor physiotherapy in order to regain her breathing capacity and allow her to be discharged from the ICU. After these 38 days, the patient was referred to the ward, where she was observed for 5 days and then discharged for outpatient follow-up.