A 23yr old male patient brought with history of hit by tractor, With dysmorphic face with active bleeding both nostrils and mouth and the left lower leg. Primary Survey with C spine stabilization: Airway-Not patent, full of bloody secretions, fall
back of tongue and fractured symphysis of mandible falls back and cause choking. DifFIcult airway anticipated and intubated with 8.0 size ET tube with in line stabilization of the c-spine and ventilator
Support Labored breathing with trachea in midline, dereased chest expansion in right side and decreased air entry.Spo2-80% with 10L o2 100%. with RR-30 breath per minute. Circulation with
hemorrhagic control-Heart rate-130 bpm,BP-?,CRT->4sec, 20 ml/kg FLuid resuscitation started and bleeding superficial vessel identiFIed controlled with pressure application and order given to
arrange PRBC. Disability-. GCS-E2,V4,M5-11/15, Irritable, Pupils- normal in size reacting to
light.Abrasion present in forehead, sutured wound of size 6*3cm in the left anterior part of the neck. X RAY: Chest-Right side Pneumothorax, C spine-Normal, Pelvis-Normal, Left tibia and fibula-Both
bone fracture, Left Femur-Displaced lower end. Urinary catheter-Placed, ICD –Placed in Right 5th ics, POP-Applied for both bone leg fracture and
femur fracture. Diagnosis Polytrauma with segmental fracture on the mandible, with displaced distal femur fracture, displaced bone fracture on the
left leg. Right side pneumothorax.
Treatment: ICD for pneumothorax, ORIF for Mandible, Surgical management for femur Retrograde inter locking nailing.And both bone fracture of leg Inter locking nailing.
