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<DIV><FONT face=Arial size=2>14 yo male MVA. Hypotensive and tachycardic on
arrival to ER. Chest X-ray revealed left hemothorax, right side obviously
normal. Initial left chest tube output is 400 cc. DPL is positive for gross
hemoperitoneum. Laparotomy: A huge diaghragmatic tear extending from crura to
the lateral chest wall, stomach, spleen, colon and KIDNEY in left thorax, a left
sided retroperitoneal hematoma. Spleen was fractured. Splenectomy was done.
Ongoing bleeding from left thorax dictated left thoracotomy and it was found
that retroperitoneal blood was travelling from down to up to the thorax and to
the abdomen through the diaphragmatic tear. MAP decreased to 30 mmHg at that
time and aorta was cross clamped, a maneuver which increased BP to 120/70.
Exploration was extanded and a total transection of the left renal vein just to
the enterance to IVC was found and fixed. Operation was completed with a total
whole blood transfusion of 9 units. 4 units of FFP were given. </FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>Postoperative serial Hb measurements are
around 10 gr/dl; chest X-ray showed pulmonary edema on the RIGHT side,
left side is OK. ABG analysis is pH: 7.29, pCO2: 43, BE: -6 but pO2:55, O2 sat:
75% (volume controlled, 100% O2, PEEP: 10 cm-H2O). Still hypotensive and
CVP: 14 cm-H2O</FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>What should we do regarding pulmonary menegament
and inotropics ?</FONT></DIV></BODY></HTML>