Akademik Veri Yönetim Sistemi
5th International Congress On Emergency Medicine “ICON-EM”, Antalya, Türkiye, 27 - 30 Ekim 2025, ss.941-943, (Özet Bildiri)
Traumatic injuries are a leading cause of morbidity and mortality in young adults.High-energy blunt trauma causing multisystem injuries requires a multidisciplinary approach in emergency settings.This case report details the clinical course and emergency management of a young male patient with severe spinal, thoracic, and abdominal injuries following blunt trauma.
Case: 22-year-old male construction worker with no known comorbidities was injured when a wooden pallet fell from a roof,trapping him between bunks while sleeping.He was brought to the emergency department by emergency medical services.Vital signs on admission included blood pressure of 75/51mmHg,pulse of 107 bpm,body temperature of 36.9°C,respiratory rate of 26 breaths per minute,and SpO₂ of 100% with 4 L/min oxygen.The patient was conscious,cooperative and oriented,with a GCS score of 15.No head or neck injuries were noted,and cervical vertebrae showed no tenderness,but thoracic vertebral tenderness was present.No ecchymosis was observed on the thorax or abdomen.Breath sounds were questionably diminished in the left hemithorax,with tenderness in the left lower ribs.Abdominal examination showed no tenderness,guarding or rebound.Upper extremities had normal motor function and sensation,but bilateral lower extremities exhibited motor and sensory loss loss of anal tone,and anesthesia below T10,indicating paraplegia.Peripheral pulses were equal, with a capillary refill time of 1 second.Bedside ultrasonography detected intra-abdominal free fluid,prompting fluid resuscitation,tranexamic acid administration,and laboratory tests. Consultations with General Surgery,Thoracic Surgery,and Neurosurgery were obtained.Due to discrepancies between physical and ultrasonographic findings,advanced imaging was planned.Computed tomography revealed displaced thoracic spine fractures(T7-T11), compression fractures at T8-T9,T8 anterolisthesis,a minimal right hemopneumothorax and left hemopneumothorax, left 9th-10th rib fractures,a sternal fracture,a grade 4 splenic laceration,hemorrhagic densities increases in perisplenic,perihepatic,paracolic,and pelvic regions,and a pelvic fracture from the right iliac bone to the acetabulum.A tube thoracostomy was performed for the left pneumothorax and hemothorax.The splenic laceration was prioritized as the most life-threatening,requiring emergency surgery,followed by planned neurosurgical intervention for spinal injuries.
Conclusions: This case underscores that physical examination may not reliably detect internal injuries in trauma patients,particularly with spinal cord injuries masking severe pathologies.Bedside ultrasonography and advanced imaging are critical for diagnosis.The coexistence of spinal,thoracic,and abdominal injuries necessitates a multidisciplinary approach with rapid intervention, prioritizing life-threatening conditions to reduce mortality and morbidity.