SILLIMAN UNIVERSITY MEDICAL SCHOOL

SUBMITTED TO: June 16, 2015

SUBMITTED BY:Cristobal, Phylicia de los Santos, Rosheil Mae Duran, Honey Rose Ejera, Alyssa Thea

I. REPRESENTATIVE CASE

IDENTIFYING DATA: 25 year old male, single from Dumaguete City, admitted for the first timeCHIEF COMPLAINT: Motor Vehicular AccidentsCHIEF COMPLAINT: Blunt abdominal Injury and BurnsNATURE OF INJURY: Motor Vehicular AccidentTIME OF INJURY: About 3:00 amDATE OF INJURY: May 23, 2015PLACE OF INJURY: Dumaguete City, Negros OrientalHISTORY OF PRESENT ILLNESS: Accident happened 5-23-2015 at 3am at Daro, Dumaguete City. Patient hit a stray dog on the street, hitting his side including his torso to the ground first. Half-Burned by hot-water on both of his lower extremities. Condition sustained for 30mins before admission. Vomitting and loss of consciousness not noted.PAST MEDICAL HISTORY: No previous hospitalization. Not hypertensive and diabetic.FAMILY HISTORY: (-)DM, (+) HPN, (-)Cancer, (-)AsthmaPERSONAL AND SOCIAL HISTORY: Alcoholic; Non-smoker

REVIEW OF SYSTEMSPHYSICAL EXAMINATION

General Survey: NormalSkin: Normal. (-) Jaundice, (-) RashesHEENT: Normal.(-) Visual changes, (-) DischargesChest and Lungs: Normal. (-) Cough,chest tightness, hemoptysisCardiovascular: Normal. No cardiac anomaliesAbdomen: Normal. No tendernessGastrointestinal: Normal bowel movement.Musculoskeletal: (-) ArthritisGenitourinary: (-) polyuria (-)pain upon urinationCNS: Normal.General Survey: Conscious, coherent, lying in bed, not in respiratory distressVital Signs:BP: 110/70 mmHg HR: 64/min RR: 18cpm O2 Sat: 98%Skin: First Degree Burns on both lower extremitiesHEENT: (-) beeding on the head, (-) sunken eyeballs, (-) dry lips, dry oral mucosae(-) nose discharges, (-)tracheal displacementChest and Lungs: (-) retractions, (-) adventitious breath soundsCardiovascular: Apical impulse at 5th ICS, (-) tachycardia, murmursAbdomen: Abdomen is soft with linear abrasions on the left flank area, limited/voluntary gurading noted. (-) Direct rebound tenderness, (-) hyperactive bowel sounds, no organomegalyDRE: No mass palpatedGUT: (-) KPSExtremities: No bipedal edema, Both lower extremities burned (scalding), good pulse noted

II. PRIMARY IMPRESSION

DIAGNOSISRULE INRULE OUT

Blunt Thoracoabdominal Trauma and 36% Scalding Inury on both Lower Extremties secondary to MVACHIEF COMPLAINT: Motor Vehicular AccidentsHISTORY OF PRESENT ILLNESS: Hits his side including his torso to the ground first. Half-Burned by hot-water on both of his lower extremities. Vomiting and loss of consciousness not noted.Skin: First Degree Burns on both lower extremitiesAbdomen: Abdomen is soft with linear abrasions on the left flank area, limited/voluntary guarding noted. (-) Direct rebound tenderness, (-) hyperactive bowel sounds, no organomegalyExtremities: Both lower extremities burned (scalding), good pulse notedLabs: No significant findings

Thoracoabdominal inuries secondary to blunt force are attributed to collisions between inured person and the external environment and to the acceleration or deceleration forces acting on the persons internal organs.CANNOT BE RULED OUT

III. DIFFERENTIAL DIAGNOSIS

DIAGNOSESRULE INRULE OUT

Penetrating Abdominal TraumaCHIEF COMPLAINT: Motor Vehicular AccidentsHISTORY OF PRESENT ILLNESS: Hits his side including his torso to the ground first. Half-Burned by hot-water on both of his lower extremitiesAbdomen: Abdomen is soft with linear abrasions on the left flank area, limited/voluntary guarding noted.

(-) Hypotension(-) Tachycardia(-) Peritoneal signs(-) Respiratory distressLab findings are normal

Abdominal Compartment SyndromeCHIEF COMPLAINT: Motor Vehicular AccidentsHISTORY OF PRESENT ILLNESS: Hits his side including his torso to the ground first. Half-Burned by hot-water on both of his lower extremities. Vomiting and loss of consciousness not noted.Abdomen: Abdomen is soft with linear abrasions on the left flank area, limited/voluntary guarding noted.

Abdominal Compartment Syndrome maybe directly related to abdominal injury where there can be compression to the organs causing impaired oxygen delivery leading to ischemia and anaerobic metabolism.(-) Wheezes, rales, increased respiratory rate(-) increase in abdominal girth(-) nausea and vomitingLab findings are normal.

ADVICE AND INFORMATION Educate the patient and his family about his condition: possible etiology, risk factors, course of disease, signs and symptoms, complications if left untreated, prognosis, and medical options for treatment including its benefits, side effects, risks and alternatives. Increasing patients knowledge about his condition improves medical compliance and assists in the management of symptoms. Emphasize the importance of medication compliance in the optimum management of his condition.

NON-PHARMACOLOGIC TREATMENT1. Admit Patient.2. Primary Survey (ABC):a. Airway. Ensure patent airway. Airway management in blunt trauma require cervical spine immobilization.b. Breathing. Supplement O2 therapy and monitor it using the pulse oximeter.c. Circulation. Monitor Vital signs such as BP and Pulse rate at least every 15 mins.3. Secondary Survey:a. GCS monitoring at least every 15 mins.b. Monitor intake and output.4. Blood crossmatching for possible surgical procedures.

FOLLOW-UP AND MONITORING1. Before discharge, provide patients with detailed instructions that describe signs of undiagnosed injury. Increased abdominal pain or distention, nausea or vomiting, weakness, lightheadedness or fainting, or new bleeding in urine or feces mandates immediate return and further evaluation.