General Surgery Grand Rounds

Dr N Singh

History
27 F No Known Chronic Illnesses Presents with Two Stab Wounds Blood soaked shirt Nil Syncope or Symptomatic Anemia Chest pain at injury , SOB , Haemoptysis Hematemesis, Vomit , Abd pain , Distension

Examination
Young female in painful distress Mucous Membranes pink and moist Anicteric, Acyanotic Vitals BP143/72, T 96.5, PR 72, RR 20 SP02 98%

Examination
Injuries
1cm stab wound, Lt hemithorax, 1st intercostal space, 1cm lateral to MCL 1cm stab wound just above right costal margin, 2cm from the midline

Chest AEEB, Nil Added Sounds

Examination
CVS:
Pulses N, normal heart sounds Distended Neck Veins Grade III/IV systolic Murmur

Abd: Soft, Flat, generalized tenderness, guarding, rebound tenderness, rigidity, BS normal, DRE normal CNS: Nil Deficit

Assessment
Multiple Stab Wounds
Likely intra-abdominal injury R/O Cardiopulmonary injury R/O Diaphragmatic injury Haemodynamically Stable

Investigations Already Done

CBC: Hb 12.3, PCV .36, WBC 7.4, Plt 242 HCG: Neg CXR: Nil Pneumothorax, haemothorax, or pneumoperitoneum. Normal cardiac silhouette

Plan
Resuscitate NPO, NGT, UCATH Prepare for Exploratory Laparotomy, Subxiphoid Window, +/- Thoracostomy tube, +/- Thoracotomy Antibiotics FAST

FAST
Nil Pericardial Effusion Free Pelvic Fluid Morrisons Pouch not visualized

OP Notes
Findings
500cc haemoperitoneum <1cm laceration to Segment 4a of Liver
No active bleed No injuries to under surface

Small haematoma to noted just adjacent to superior border of D1 Normal Stomach, pancreas, deudenum, small and large bowel and GB Nil retroperitoneal haematoma Straw Coloured fluid from Pericardial Sac

Post OP
Patients Course has been uneventful thus far Patient to have Arterial Doppler as an outpatient