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Draft

Regional Clinical Hospital State Budgetary Institution

г. Tver, 105 Peterburgskoe sh. Tel. for information: 77-54-00. Website: OKB-Tver. RF

Department of Anesthesiology and Resuscitation

Tel. 77-53-76

Discharge summary

From the medical record of an inpatient No. 2022 011478

Patient's name: Daria Gennadyevna Rudenko Date of birth: November 14, 1996

Passport: No. Policy: №205308778 (5 MAKS-M).

Address: Ukraine Kharkiv Industrial District pr.Moskovskyi d.264 kv 34. Tel... El.

mail:.

I was under treatment from 06/16/2022 to 08/02/2022.

Diagnosis final clinical main

T06.8 Severe combined trauma. CMI. Moderate degree contusion of the brain. Fracture of the right
temporal bone with transition to the skull base. MIFT: Multiple comminuted fracture of the bodies,
arches, and transverse processes of the Th7, Th8 vertebrae with complete rupture of the spinal cord at
this level. Traumatic spondyloptosis of Th7, Th8 vertebrae. Fracture of the arches and transverse
processes of the C6, C7 vertebrae. Fractures of the transverse processes of Th1-Th6 vertebrae on the
left side. Fracture of transverse process and arch of Th6. Fracture of transverse process of Th9 vertebra
on the right. MSTC: Multiple fractures of ribs 2,3,5,6,7,8 on the left, 4,6 ribs on the right. Pulmonary
contusion. Right-sided hydrothorax. Multiple contusions of soft tissues of the face, torso, and
extremities.

Diagnosis-complication of the underlying

Bilateral lower lobe pneumonia. AIVL of 09.06.22. Lung abscess. Intermediate acute respiratory distress.
Multiple organ failure syndrome. SOFA score 10.

Diagnosis clinical concomitant.

Lung contusion. Right-sided hydrothorax. Multiple contusions of soft tissues of face, trunk, extremities.

Complaints

does not present because of the severity of his condition

From the anamnesis.

Trauma 09.06.2022 about 12:20, involved in a traffic accident, was a passenger. She was admitted to the
intensive care unit of Velikoluk inter-district hospital. Where a CT scan of the GM, OGC, OPP, pelvis was
performed, where she was treated until 6/16/2022. On June 16, 2022 she was transported to Regional
Hospital for further examination and decision on treatment according to agreement with hospital
administrations.

At the time of hospitalization

General Inspection

The general condition is extremely severe. Normosthenic constitution. There were vesicular rashes on
the skin of the anterior chest wall. Numerous subcutaneous hematomas on the torso and extremities.
Facial precipitation. Subponeurotic hematoma in left frontal area soft to the touch. Ectericity of the
sclerae. Traces of dried blood in the area of the right external auditory canal. A CPV was placed in the
right subclavian vein. The skin around the IVC showed no signs of inflammation, the dressing was clean.
A pleural drainage was placed on the left side. The skin around the drainage showed no signs of
inflammation, the dressing was clean. BP 118/74 mmHg. BP 78 per min, rhythmic. Breathing IVL through
TST, weakened in the lower regions. The abdomen is soft, unresponsive to palpation. Symptoms of
peritoneal irritation were negative. The liver at the edge of the rib arch. The kidneys are not palpable.
No edema. Urination through a urethral catheter, the urine is light yellow in color.

Neurological status: Medically sedated to coma 2 (5 points on FOUR). Not accessible to productive
verbal contact due to severity of condition. No response is elicited to painful stimuli. With passive
opening of the eyelids, the pupils are fixed in the center. The reaction of the pupils to light, direct and
concomitant, is preserved, flaccid. The corneal reflex is preserved, flaccid. Resists the ventilator . There
were no meningeal symptoms. No spontaneous nystagmus. He does not respond to palpation of the 5p
branch exit points. The face is symmetrical. Tongue is in the mouth, not accessible to examination.
Muscle tone is diffusely reduced. Reliably, muscle strength in the extremities cannot be determined.
Tendon reflexes, D=S flaccid. No pathological foot reflexes were evoked. Sensitivity and coordination
tests cannot be reliably checked because of the severity of the condition.

Locally: There are vesicular rashes on the skin of the anterior chest wall. Numerous subcutaneous
hematomas on torso and extremities. Facial precipitation. Subponeurotic hematoma in left frontal area
soft to the touch. Ectericity of the sclerae. Traces of dried blood in the area of the right external auditory
canal.

Survey conducted

16.06.2022 MSCT - brain, thorax, OBP, and ZBP with pelvic bone

Fractures of the left and right arches of C6, right and left arches and left transverse process of C7, and
left transverse processes of Th1 2 3 4 5 6 vertebrae are detected at the level of scanning. There are
fractures of posterior segments of 2 3 5 6 7 8 ribs on the left and posterior segments of 4 6 ribs on the
right. Fractures of articular processes, bodies and arches of Th7 Th8 vertebrae with lateral displacement
of bodies to the left up to 33 mm and caudo-cranial displacement up to 20 mm are noted. There is a
complete rupture of the spinal cord at this level.

The structures of the brain are properly developed.

Differentiation of gray and white matter is distinct. No areas of pathological density were found in the
brain parenchyma.

The ventricles of the brain are not dilated, the lateral ventricles are symmetrical.

There is no displacement of midline structures.

The subarachnoid spaces of the convexital surface are not deformed, somewhat narrowed.

The cisternal spaces are not dilated or deformed.

The Turkish saddle is not enlarged, the pituitary gland is intrasellar, not enlarged in size, and its structure
is homogeneous. The parasellar structures are unchanged. Hemispheres of the cerebellum were not
changed. No additional masses in the area of the pontocerebellar corners were found. The internal
auditory canals were not enlarged and were symmetrical.

The paranasal sinuses are properly developed, their pneumatization is ousted due to the pathological
component and thickening of the mucosa.

No bone-traumatic changes of the bones of the skull base and skeleton were revealed.

A subaponeural hematoma up to 10x52x34 mm was detected in the soft tissues of the left frontal and
temporal region.

The distal end of the right-sided DIC in the lumen of the VEP.

There is a tracheostomy tube in the tracheal lumen, position is typical.

There is a nasogastric tube in the esophageal lumen.

On the left side, approximately along the midclavicular line, a drainage was placed through the 4th m/yr.
The drainage passes through the upper lobe parenchyma, its distal end being defined paravertebrally at
the level of the posterior 5th rib on the right.

The shape of the thorax is normal.

The volume of the inferior right is reduced due to hydrothorax.

There is total thickening of the lung tissue of the lower lobe on the right and subtotal on the left by the
type of consolidation, the bronchial lumen can be seen against these changes.

There are also multiple paravascularly spaced areas of consolidation in the upper lobes on both sides up
to 10 mm.

Vascular pattern and interstitium are not changed.

The trachea was without features. The bronchi of orders 1-3 are passable, without areas of narrowing
and thickening of the walls.

The mediastinal structures are differentiated, no mediastinal displacement or additional masses in the
mediastinum were detected.

The heart has a normal configuration, the heart chambers are not dilated. The pericardial leaflets are
not thickened, and there is no fluid in the pericardial cavity.

The thoracic portion of the aorta is unchanged.

Lymph nodes are not enlarged.

Pleural sheets were not thickened, the right pleural cavity showed homogeneous free fluid with an
average density of 20HU, separation of pleural sheets up to 20 mm. The diaphragm is normally spread,
its contours are even, clear, and its sinuses are free. The soft tissues of the thorax were not altered.

There is no free gas in the abdominal cavity. A small amount of free homogeneous fluid is detected
along the flanks, in the subhepatic space, and in the pelvis.

The intestinal loops were not distended, no "fluid-gas" levels were detected in them.

The liver is normally located, the size and shape of the liver are unchanged. The parenchyma structure is
homogeneous, without areas of pathological changes in density. Intrahepatic bile ducts were not
enlarged. Gallbladder is normally located, not enlarged in size. The bladder walls were not thickened, its
content was homogeneous. The common bile duct was not enlarged, no pathological masses in its
lumen were visible. The portal and splenic veins were not enlarged.

The spleen is of normal size and shape, the parenchyma structure is homogeneous.

The pancreas is not enlarged. The outer contours of the gland are clear and even.

Parenchyma is homogeneous, without areas of pathological density. Virsung's duct was not dilated. The
parapancreatic fibers were not changed. The mesenteric root and mesenteric vessels were not changed.

The adrenal glands are not enlarged in size, their shape is not changed.

The kidneys are normally located, and the size of the kidneys corresponds to the constitution. The
contours of the kidneys were clear and even. The parenchyma was homogeneous, both renal hormones
were not enlarged, not deformed, and contained no concrements. The ureters were not dilated, no
concrements were visualized in them.

Lymph nodes of the abdominal cavity and retroperitoneal space are not enlarged.

Abdominal aorta and large vascular trunks of abdominal cavity without visible changes.

Bones of the pelvis - without traumatic changes

Conclusion: The CT picture may correspond to the manifestations of cerebral edema. Focal changes in
the brain structures were not detected. Subaponeural hematoma on the left side. CT signs of
pansinusitis.

CT signs of bilateral lower lobe pneumonia with atelectatic component. Areas of consolidation in the
upper lobes on both sides should be differentiated between parts of bronchogenic detachment and lung
contusions.

Right-sided hydrothorax.

A small amount of free fluid in the abdominal cavity and pelvis. Abdominal and retroperitoneal organs
without visible pathological changes.

CT signs of multiple fractures of ribs, vertebral arches and processes with displacement of Th7 Th8
bodies with spinal cord rupture at this level.

06/17/2022 ECG

Conclusion: June 16, 22 Ms. sinus tachycardia with a heart rate of 129 beats per minute.

The vertical direction of the E.O.S.

Endoscopic examination 17.06.2022

FBS is performed through the TC. The position of the tube is correct, above the carina. The
mucosa of the trachea areas accessible for review is edematous, friable, hyperemic. The carina was
sharp, mobile. BP mucosa was markedly edematous and hyperemic. The spurs were acute. The mouths
of the visible bronchi were moderately narrowed due to edema, there was a moderate amount of
mucous secretion in the lumen. Sanation of the TBD with 0.9% NaCI 40.0, aspiration. The apparatus was
removed, no complications.

Conclusion: catarrhal diffuse bilateral endobronchitis

20.06.2022 ECG
 Conclusions: Rhythm: sinus rhythm with heart rate 59 beats/min. Electrical axis of the heart is
vertical, ST elevation in the leads, assess clinically - exclude early ventricular repolarization syndrome

21.06.2022 Abdominal ultrasound examination

Results of the study

The examination was carried out on a portable Aloka device in the intensive care unit ward, with
the patient only "lying on his back", against the background of the patient's serious condition
(monopositionally).

The liver is located normally, its contours are clear. The shape and size of the liver are
unchanged. Echostructure of the liver is homogeneous, echogenicity is unchanged. Vascular pattern is
quite pronounced, well traced to peripheral areas. The portal vein was 9 mm, the common bile duct had
an inner diameter of 2-3 mm, it was 30 mm across in the proximal part. Intrahepatic bile ducts were not
dilated.

A large number of concrements up to 5 mm in the gallbladder cavity are visualized, giving an

acoustic shadow

The pancreas is not enlarged and visualized. The contours of the gland are clear, the echogenic
structure is homogeneous, echogenicity is unchanged.

Dilation of the pancreatic duct is not detected.

The spleen is located in its typical location, its contours are smooth, clear, and it is not enlarged
in size

No free fluid in the abdominal cavity was detected.

Conclusion

Cholecystolithiasis

21.06.2022 Ultrasound of lower extremity vessels

Type of research

Ultrasound duplex scanning of deep and superficial venous systems of lower extremities

Results of the study

The left/right deep veins of the lower extremities (femoral (common, deep, superficial),
popliteal, tibial (anterior, posterior) were scanned and passed all over, the walls were not thickened,
fully compressed by the probe. No intraluminal masses were detected.

The right/left BPV is not dilated. No intraluminal masses were detected.

The IVP on the right/left was not dilated. No intraluminal masses were detected.

Conclusion

No pathology from the deep and superficial venous systems of the lower extremities on the
right left was detected.

ECHOCARDIOGRAPHY 22.06.2022

Rhythm: sinus tachycardia

Results of the study

On his back, on the ventilator.

LEFT PRE-HEART is 2.9 cm (N: 23-40 mm), its volume is 32 mL (N: not>22±6 mL/m²).

Mitral valve: no features. Transmitral blood flow velocity: 0.78 m/s (N = 0.6-1.3), regurgitation - 0
degree.

LEFT VENTRICLE:

Interventricular septal thickness - 0.8 cm (N:W<9mm M<10mm), posterior wall thickness - 0.8 cm (N:
W<9mm m<10mm). End diastolic dimension - 4.0 cm (N: W<53mm M<59mm). End diastolic volume - 78
ml (N: not>35-75ml/m2).

Diastolic function was not impaired. No abnormalities of local contractility were detected. Ejection
fraction (Simpson) was 62% (N: 55-75%).

RIGHT PRINCIPLE - 3.2 cm (N: <45 mm).

RIGHT VENTER - 2.5 cm (N: not>30 mm), not enlarged in the 4-chamber position (N:not>33 mm).

AORTA-Root diameter is 3.0 cm (N: 24-39 mm), ascending section is 3.0 cm.

The aortic valve is tricuspid, the amplitude of gate opening is sufficient - 1.8 cm (N: >14 mm). Blood flow
velocity - 1.17 m/s (N=1.0-1.7), regurgitation 0 std.

In the descending aorta, the blood flow rate is not detected.

Tricuspid valve - blood flow velocity - 0.56 m/s, regurgitation - 1 st.

Pulmonary artery - diameter - 1.7 cm, blood flow velocity - 0.82 m/s, regurgitation - 1st stage.

Inferior vena cava 1.6 cm - not dilated, collapsing on inspiration less than 50%.

There is no effusion in the pericardial cavity.

Systolic pulmonary artery pressure calculated from tricuspid regurgitation flow velocity - 16-18 mmHg
(<30 MM Hg).

Comments: No shunt bleeding discharges were detected at CDC.

Conclusions: Size of cardiac cavities and their functional state are within normal limits. Valvular function
without hemodynamically significant pathology.

25.06.2022 Otorhinolaryngologist

T88.9 Tracheostomy infection

27.06.2022 KpOBb Ha geMoCulture

< No microflora growth detected

Electrocardiography 27.06.2022

Conclusions: Rhythm: sinus rhythm with heart rate of 96 beats/min. Electrical axis of the heart is
vertical, overload of the left ventricle, impaired repolarization process in the lower parts.
CT investigation 30.06.2022

MSCT of the cervical spine

MSCT of the thoracic spine

Results of the study

A series of tomograms and multiplanar reconstructions revealed pathological kyphosis at the level of
Tn7-Tn8. The ratio of these vertebrae in the spinal column axis is distorted. Complete lateral fracture-
dislocation of Tn7-Tn8 vertebral bodies is visualized. The bodies of these vertebrae were displaced to
the left relative to the spinal axis, by a width greater than the width of the vertebral bodies, about 36
mm, the latter extending into the pleural cavity, compressing the lower lobe of the left lung. The
fragments of the posterior vertebral body complex are located in the lumen of the vertebral canal of
paravertebral soft tissues in the form of multiple fragments. There is a complete rupture of the spinal
cord at this level. Linear fractures of transverse processes Tn1, Tn2, Tn3, Tn4, Tn5, Tnb on the left and
Tn9 on the right, fracture of the right arches Tn6, posterior segments of 2, 3, 5, 6, 7, 8 ribs on the left,
and posterior segments of 4, 6, 11 ribs on the right remain.

Conclusions: CT picture of multiple fractures of the posterior segments of the right and left halves of the
thorax, transverse processes of the bodies of Tn1, Tn2, Tn3, Tn4, Tn5, Tn6 vertebrae on the left. Tn9 on
the right, fracture of the right Tn6 vertebral arches. Torsion-distraction multi-dislocation fracture of the
bodies of Tn7-Tn8 vertebrae with signs of complete rupture of the spinal cord at this level. AO SPINE C3.

RESULTS: Spiral computed tomography of the cervical spine with subsequent construction of reforms
(MPR, 3D): Physiological lordosis kyphosis straightened. Vertebral bodies C1-C2-C3-C4-C5-C7 of normal
configuration, vertebral structure unchanged, trabecular pattern not disturbed. The height of the
intervertebral discs was not reduced. There were no local herniation and no pronounced protrusion. The
right occipital condyle fracture was preserved, without deformation and compression of the surrounding
structures. There were linear fractures of the right and left pedicle-arc C6 with the fracture line
extending to the spinous process and displacement of the body of the Cb vertebra anteriorly up to 4
mm; fractures of the pedicle base and the roots of the arches, the left transverse process C7. No
significant displacement of fragments was observed. The articular joints were unchanged. Paravertebral
soft tissues of normal structure, somewhat thickened at the level of traumatic changes. Atlanto-occipital
and atlantoaxial articulations were not deformed, their relationships were not disturbed. Abnormal
bone arches around the subcranial sections of the vertebral arteries were not clearly detected. The
intervertebral joint gaps were not reduced in height.

Conclusions: CT picture of tearing fracture of the right condyle of the occipital bone, linear fractures of
the C6 pedicle-arc with up to 4 mm antelisthesis of the body, fractures of the pedicle base and roots of
the arches, left transverse process of the C7 vertebra.

Endoscopic examination 01.07.2022

Protocol: FBS performed via TST. The position of the cannula is correct, above the carina. The mucosa of
the trachea areas accessible for review was moderately focally hyperemic. The carina was sharp, mobile.
BP mucosa pronounced moderately hyperemic. Spurs are acute. The orifices of visible bronchi were
moderately wide, there was moderate amount of mucous secretion in the lumen. Sanation of the TBD
with 0.9% NaCI 40.0, aspiration. The apparatus was removed. There were no complications.

Conclusion: Diffuse bilateral catarrhal endobronchitis.

Bronchoalveolar lavage

CT investigation 14.07.2022
CT-GOP

Results of the study

In a series of tomograms and multiplanar reconstructions, the condition after C6-C7 discectomy. Open,
combined reduction of the C6 vertebra. Peripheral spondylodesis C6-C7 with autograft from the left iliac
crest with fixation of C6-C7 bodies with a titanium plate. Decompressive laminectomy Tn7-Tn8, 1/2 Tn6,
Tn9 removal of vertebral body fragments and cusps from the lumen of the spinal canal, washing of
deuteritis with suturing of multiple TMO tears using tachocomb and Bioglu glue. Unloading
subarachnoid drainage with a lumbar catheter. Percutaneous spondylodesis Tn5,6,9,10 with a titanium
cannulated system. The C6-C7 segment was fixed with a titanium plate and 4 screws passing through the
vertebral body. The screws of the fixation system did not extend beyond the vertebral bodies, and there
were no areas of density loss in the structure of the vertebral bodies at the level of the structure.
Titanium screws were installed in the bodies of Tn5-6-8-9 vertebrae on the right and left. The position is
correct. A lumbar probe was visualized in the area of surgical intervention. Soft tissues are somewhat
edematous, with inclusions of air bubbles and bone fragments. Complete lateral fracture-dislocation of
Th7-Tn8 vertebrae is visualized. The bodies of these vertebrae were displaced to the left relative to the
spinal axis, by a width greater than the width of the vertebral bodies, about 36 mm, the latter were
pushed into the pleural cavity, compressing the lower lobe of the left lung. There is a complete rupture
of the spinal cord at this level. Linear fractures of the transverse processes Tn1, Tn2, Tn3, Tn4, Tn5, Tn6
on the left remain. Tn9 on the right, fracture of the right Tn6, posterior segments of 2, 3, 5, 6, 7, 8 ribs
on the left, posterior segments of 4, 6,11 ribs on the right.

Conclusion: condition after discectomy of C6-C7. Open, combined reduction of the C6 vertebra. Anterior
fusion of C6-C7 with autograft from the left iliac crest with fixation of C6-C7 bodies with a titanium plate.
Decompressive laminectomy Tn7-Tn8, 1/2 Tn6, Tn9 removal of vertebral body fragments and cusps
from the lumen of the spinal canal, washing of deuteritis with suturing of multiple TMJ tears using
tachocombe and Bioglu glue. Unloading subarachnoid drainage with a lumbar catheter. Percutaneous
spondylodesis Tn5,6,9,10 with a titanium cannulated system.

CT investigation 19.07.2022

CT scan - chest organs

Results of the study

Right-sided CPV in the ERV projection. Lung volume is preserved, lung fields are symmetrical. No focal
changes in the lungs were revealed. Areas of infiltrative changes were visualized in the lower lobes of
both lungs. Also in the area of complete lateral fracture-dislocation of Tn7-Tn8 vertebral bodies an
inifiltrate, rounded shape, containing fluid and gas (abscess) is detected. The paravertebral tissues are
edematous and heavy. Vascular pattern and interstitium were not changed. The trachea had no
features. Bronchi of orders 1-3 were passable, without areas of narrowing and thickening of the walls.
The mediastinal structures are differentiated, no mediastinal displacement or additional masses in the
mediastinum were found. The heart has a normal configuration, heart chambers are not dilated. The
pericardial leaflets were not thickened, there was no fluid in the pericardial cavity. The thoracic portion
of the aorta was not changed. Lymph nodes were not enlarged. The pleural leaflets were not thickened,
and there was no fluid in the pleural cavities. The diaphragm is normally decomposed, its contours are
even, clear, and the sinuses are free.

Ultrasound of lower extremity vessels 19.07.2022

Ultrasound duplex scanning of deep and superficial venous systems of lower extremities

Results of the study

The left/right deep veins of the lower extremities (femoral (common, deep, superficial), popliteal,
mibial (anterior, posterior) are completely passable, the walls are not thickened, fully compressed by
the probe. No intraluminal masses were detected. The right/left BPV was not dilated. No intraluminal
masses were detected.

The IVP on the right and on the left was not dilated. No intraluminal masses were detected.

Conclusion

. No pathology of the deep and superficial venous systems of the lower extremities on the right/left

CT investigation 25.07.2022

Thoracic MSCT

Results of the study

Condition after surgical treatment (installation of transpedicular fixation system). The distal end of the
left-sided ATC in the projection of the ER.

Drains are visualized:

-from the level of the Th5 vertebral body, in the spinal canal, a drainage is defined, the distal end at the
level of the MPD of the Th10/11 vertebral bodies;

- in the soft tissues of the paravertebral region on the right, at the level of the body of the TH5 vertebra,
distal end of the 2nd drain.

The shape of the thorax is normal. Lung volume was preserved, pulmonary fields were symmetrical. No
focal changes in the lungs were detected. In both lungs there were visualized areas of pulmonary
thickening of varying intensity, in the lower lobes there were areas of atelectatic changes. In the area of
complete lateral fracture-dislocation, at the level of bodies of Tn7-Tn8 vertebrae on the left, an
infiltrate, rounded in shape, containing fluid and gas (abscess), 30x32 mm in size, with a wall up to 4 mm
thick is determined (without pronounced dynamics as compared to the examination of 19.07.).

The paravertebral tissues were edematous and heavy. In comparison with the previous study, negative
dynamics in the area of intervention (more on the left side) was noted in the form of infiltrate formation
with signs of infection.

Vascular pattern and interstitium were not changed. The trachea had no features. The bronchi of the
1st-3rd orders were passable, without areas of narrowing and thickening of the walls. The mediastinal
structures are differentiated, no mediastinal displacement or additional masses in the mediastinum
were found. The heart has a normal configuration, heart chambers are not dilated. The pericardial
leaflets were not thickened, there was no fluid in the pericardial cavity. The thoracic portion of the aorta
was not changed. Lymph nodes were not enlarged. Pleural leaflets were not thickened, fluid in pleural
cavities was up to 13 mm thick on the right and up to 4 mm thick on the left. The diaphragm is normally
spread, its contours are even and clear.

ECHOCARDIOGRAPHY 01.08.2022

Results of the study

On the back.
LEFT PRE-HEART is 2.7 cm (N: 23-40 mm), its volume is 28 ml (N: not>22±6ml/m²).

Mitral valve: no features. Transmitral blood flow velocity: 0.67 m/s (N = 0.6-1.3), regurgitation - 0
degree.

LEFT VENTRICLE:

Interventricular septum thickness -0.8 cm (N:W<9mm m<10mm), posterior wall thickness 0.8 cm (N:
W<9mm m<10mm). End diastolic dimension - 3.5 cm (N: W<53mm m<59mm). End diastolic volume - 66
ml (N: He>35-75ml/m²).

Diastolic function was not impaired. No abnormalities of local contractility were detected. Ejection
fraction (Simpson) was 65% (N: 55-75%).

RIGHT PRINCIPLE - 3.2 cm (N: <45 mm).

RIGHT VENTER - 2.5 cm (N: not>30 mm), not enlarged in the 4-chamber position (N: not>33 mm).

AORTA-Root diameter is 3.0 cm (N: 24-39 mm), ascending section is 3.0 cm.

The aortic valve is tricuspid, the amplitude of gate opening is sufficient - 1.8 cm (N: >14 mm). Blood flow
velocity - 1.1 m/s (N=1.0-1.7), regurgitation 0 std.

In the descending aorta, the blood flow rate is not detected.

Tricuspidal valve - blood flow velocity - 0.56 m/s, regurgitation - 1 st.

Pulmonary artery - Diameter - 1.7 cm, blood flow velocity - 0.86 m/s, regurgitation - 0 degree.

The inferior vena cava is not dilated, collapsing on inspiration more than 50%.

There is no effusion in the pericardial cavity. Free fluid in the right pleural sinus in insignificant amount.

Systolic pulmonary artery pressure calculated from tricuspid regurgitation flow velocity - 16 mmHg (<30
mmHg).

Comments: No shunt bleeding discharges were detected at CDC.

Conclusions: Size of cardiac cavities and their functional state are within normal limits. Valvular function
without hemodynamically significant pathology. Free fluid in the right pleural sinus in insignificant
amount.

02.08.2022 General Sysmex: WBC white blood cells: 6.30 10^9/l; RBC red blood cells: 2.71 10^12/l; HGB
hemoglobin: 78 g/l; HST hematocrit: 24.0%; MCV cf erythrocyte volume: 88.6 fl; MSN content of Hb in
erythrocyte: 28.8 pg, MSNS cong Hb in erythrocyte: 325 g/l; PLT platelets: 332 109/l; RDW-SD spread er-
std off: 53.1 fl; RDW-CV spread er-coefficient var: 16.5%; PDW wide spread thrombus: 8.6%; MPV cf
platelet volume: 9.0 fl; R-LCR % large platelets: 15.5%; PCT thrombocrit: 0.30%; NRBC# nucleus-derived
erythral: 0.00 10^9/l; NRBC% nucleus-derived erythral: 0.0%; MicroR microcytes: 3.4%; MacroR
macrocytes: 3.3%; IP messages: IG Present Anemia; Sysmex leukoformula: NEUT% neutrophils: 66.2%;
LYMPH% lymphocytes: 20.6%; MONO% monocytes: 8.4%; E0% eosinophils: 1.3%; BASO% basophils:
0.5%- IG% immature granulocytes: 3.0%; total leukocytes: 100.0%; NEUT# neutrophils: 4.17 10^9/l;
LYMPH# lymphocytes: 1.30 10^9/L; MONO# monocytes: 0.53 10^9/L; E0# eosinophils: 0.08 10^9/L;
BASO# basophils: 0.03 10^9/L; IG# immature granulocytes: 0.19 10^9/L; Leukoformula pathology:
basophils: 1.0%; eosinophils: 0.0%; blast: 0.0%; promyelocytes: 0.0%; myelocytes: 2.0%;
metamyelocytes: 0.0%; stab neutrophils: 1.0%; segmented neutrophils: 70.0%; lymphoblasts: 0.0%;
prolymphocytes: 0.0%; lymphocytes: 21.0%; monocytes: 5.0%; plasma: 0.0%; atypical mononuclears:
0.0%; total leukiforms: 100%; Altered erythrocytes: anisocytosis: +

Venous glucose: 5.30 mmol/L; Total protein: 58.8 g/L; Urea: 9.45 mmol/L; Creatinine: 36.4 µmol/L;
Potassium: 4.3 mmol/L; Sodium: 141.0 mmol/L; Total bilirubin: 15.0 µmol/L; Prothrombin index: 76.0%;
APTV: 23.0 sec.Fibrinogen: 2.100 g/l; INR: 1.12 units; Amylase: 47.6 units/l; AST: 14.6 units/l; ALT: 28.4
units/l Procalcitonin: 0.17 ng/mL General analysis: specific gravity: 1036 g/cc.cm; color: straw-yellow;
transparency: turbid; reaction: alkaline; protein quality: +; protein quantity: 0.04 g/L; sugar quality: --;
squamous epithelium: 0-0-1; transitional epithelium: 0; renal epithelium: none; leukocytes: 0-0-1;
erythrocytes: 15-20; hyaline cylinders: none; granular cylinders: none; waxy cylinders: none; mucus:
none; bacteria: --; salts: none; fungal elements: spores

Surgery, type of anesthesia

11.07.2022 Discectomy C6-C7. Open, combined reduction of the C6 vertebra. Anterior fusion of C6-C7
with an autograft from the left iliac crest with fixation of C6-C7 bodies with the titanium plate "Atlantis"
by Medtronic. 11.07.2022 Decompressive laminectomy Th7-Th8, 1/2 Th6, Th9 removal of vertebral body
fragments and arches from the lumen of the spinal canal, deuterotomy with suturing of multiple TMJ
tears with additional plasty of multiple TMJ tears using Tachocomb and Bioglu glue. Unloading
subarachnoid drainage with a Medtronic lumbar catheter. Percutaneous spondylodesis of Th5,6,9,10
with a titanium cannulated polyaxial Viper 2 system from DePew.

Treatment performed

During her stay in the hospital she received: anti-inflammatory, analgesics, antibiotic therapy, nootropic,
antioxidant therapy, and physical therapy.

Dynamics of well-being and condition during the period of treatment

During his stay in the hospital, positive dynamics were observed.

Objective status at discharge

General condition is severe, due to the severity of the underlying and concomitant pathology, the
nature of the surgical intervention performed. The skin was dry and warm. Breathing is spontaneous
through the natural airways, rhythmic, of sufficient depth, heart rate up to 16/min. Auscultatively,
breathing is on 2 sides, weakened in the lower parts, more on the left side. Hemodynamics is stable,
without inotropic and vasopressor support. Heart tones are sonorous, rhythmic. NIBP 110/65 mmHg.
Heart rate 72 bpm. Pulse on the radial arteries of good filling, rhythmic, no deficit. The abdomen is
elevated, and the abdomen participates in breathing. On palpation, the abdomen is soft, unresponsive,
painless. Peristalsis is audible. Urination by urethral catheter, yellow urine. Body temperature 37.2°C.

Neurologically: LEVEL of consciousness - clear (15 points on the Glasgow brain coma scale). She is
accessible to productive contact, completes tasks, speech is whispered, speaks in phrases. Eyeball
movements are preserved. Reaction of pupils to light, direct and cooperative, alive. The corneal reflex is
preserved. There were no meningeal symptoms. He does not respond to palpation of the exit points of
the branches of the 5p. The face is symmetrical. Tongue in the mouth, pointing along the midline.
Swallowing is not impaired. Appetite is satisfactory. Cough reflex is elicited, weakened. Muscle strength
is tetraparesis - upper distal paraparesis to 2 points on the right, 3-3.5 points on the left, lower
paraplegia. Tendon reflexes, D=S flaccid. No abnormal foot reflexes were evoked. Sensitivity and
coordination tests could not be reliably checked due to the severity of the condition.

Local status dynamics

Secondary tension healing of a p/o wound of the thoracic spine

The achieved effect of the treatment

The achieved effect of the treatment is an improvement.

Recommended by

At present, conservative therapy and stabilization of pulmonary pathology are being carried out. The
tracheostomy is functioning.

The patient does not need any medical treatment.

Physician: __________________________ (Candidate of Medical Sciences S.N. Rudnev)

Acting Head of OAIR №1: __________________________ ((Dolmatova M.V.))

I am acquainted with the data of the discharge epicrysis,

The discharge epicrysis was handed out.

Rudenko D.G. ________________________________ "___"20___.