The patient underwent Rapid Sequence Induction (RSI) and midline laparotomy was performed. She was transfused with red blood cells and taken immediately to the operating theatre for exploratory laparotomy.Ĭoronal CT demonstrating splenic laceration with surrounding free fluid. Upon transfer from CT machine to barouche the patient became haemodynamically unstable with a blood pressure of 80/40 and tachycardia at 130. Imaging showed a moderate volume of free intra-abdominal fluid ( Image 1), a distended stomach with transection of the gastroduodenal junction ( Image 2, Image 3, Image 4), and splenic injury ( Image 5). She was taken immediately for Computer Tomography (CT) imaging from the trauma bay. She had multiple superficial abrasions, a generally tender abdomen, an unremarkable chest X-ray, and a negative Focused Assessment of Sonography in Trauma (FAST) scan. Primary survey showed a patent airway, equal air entry, tachycardia of 110 bpm and blood pressure of 130/60. She was retrieved from the scene to a tertiary trauma centre via ambulance. She has no significant family or psychiatric history. She was heavily intoxicated at the time of the RTA. She had a past surgical history of only bilateral breast implants, took no regular medications and had no pre-existing medical conditions. The 2 other occupants sustained minor injuries. The accident occurred in urban South Australia. The car had no airbags and was right hand drive. Her seatbelt was worn with the shoulder strap sitting under her left axilla. She was the restrained front seat passenger in a car vs. An improperly worn seatbelt, as will be described in the following case, can cause significant injury. Presence of soft tissue injury as a result of a seat belt, known as “seat belt sign,” is a predictor of further underlying internal injury and is a diagnostic aid to clinicians managing trauma, ,, , ]. Evidence demonstrated that unrestrained passengers in similar RTA’s had significantly worse injury and outcomes, , ]. Cervico-thoracic spinal injury, sternal fracture, and pelvic fracture were thought to be initially associated with these restraints. ģ point harnesses are designed to distribute the force of deceleration to the clavicle, sternum and pelvis. This coupled with public education campaigns resulted in a significant reduction in RTA related mortality and morbidity at this time. Australian legislation was implemented in the early 1970’s and standardised seat belt fitting and wearing became mandatory. These evolved into automotive use over decades and the 3 point harnesses found in every modern car were first installed in a Volvo in 1959. Rudimentary seatbelts were first developed in the late 1800’s for the purpose of air travel. Australian data is consistent with global trends demonstrating increasing morbidity and mortality due to RTA. By 2030 trauma is expected to be the leading cause of permanent disability worldwide. Trauma accounts for 30% of intensive care admissions in America and is currently the 3 rd leading cause of permanent disability. Trauma is the leading cause of death among young people and despite developments in automotive safety the road traffic mortality rate is increasing. This equates to 2.5% of global mortality. doi:10.1016/j.jemermed.2020.06.Road traffic accidents (RTA) are responsible for 1.4 million deaths annually. (2020) The Journal of emergency medicine. Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive. Shreffler J, Shreffler SA, Shreffler SM, Shreffler RA, Shreffler BJ, Shreffler NN, Shreffler HB, Shreffler HM, Shreffler. Radiographics : a review publication of the Radiological Society of North America, Inc. Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury. Bates DD, Wasserman M, Malek A, Gorantla V, Anderson SW, Soto JA, LeBedis CA. Abdominal injury patterns in patients with seatbelt signs requiring laparotomy. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Seat belt injuries: radiologic findings and clinical correlation.
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