The critical role of anaesthesia in multifaceted care for severe thoracic trauma: A case study

Abstract

Blunt trauma to the thorax can be viciously dangerous and carries high mortality which warrants aggressive resuscitation and life-saving measures failing which cardiac arrest can occur. We present a case of a polytrauma male patient in the emergency department with diaphragmatic rupture, and bilateral pelvic and clavicular fractures in hypovolemic shock which progressed to cardiac arrest. The patient was immediately resuscitated with Cardiopulmonary and cerebral resuscitation (CPCR) according to Advanced cardiac life support (ACLS) guidelines and stabilized with intravenous fluids and further optimized with blood products. He was operated on for diaphragmatic rupture and shifted to intensive care where he was paralysed and kept on mechanical ventilation for 48 hours treated for severe metabolic acidosis and hemodynamic instability following which he was weaned off successfully. During his stay, he was evaluated for pelvic and clavicular fractures and treated for ICU-related delirium and Methicillin Resistant Staphylococcus infection(MRSA). Our case suggests that diaphragmatic injuries are uncommon but deadly in cases of abdominal forceful trauma because they can result in hemothorax and the movement of intestinal contents into the thoracic cavity. Such cases must be managed with clinical knowledge employing expedient surgical care and the best critical care. This case demonstrates the indispensable and undeniable contributions by anaesthesiologists who assume multiple roles within a hospital setup.