When “Adequate” MAP Is Not Enough: Underresuscitation as a Driver of Multiple Organ Dysfunction Syndrome in Polytrauma
DOI:
https://doi.org/10.22146/jka.v13i3.14669Keywords:
Polytrauma, Multiple Organ Dysfunction Syndrome, Shock, Resuscitation, Mechanical VentilationAbstract
Case: Male, 68 years old, with a history of coronary heart disease and stroke, had shock due to kidney trauma, tension pneumothorax, hemothorax, multiple rib fractures, complete left radius fracture, and right frontal laceration following a traffic accident while driving a car. The patient underwent fluid resuscitation, placed water seal drainage (WSD), and administered dobutamine and norepinephrine via central access in the emergency department. The patient was then transferred to the high care unit (HCU). After 31 hours of treatment, the patient experienced multiple organ dysfunction syndrome (MODS), then treated in the intensive care unit (ICU) on mechanical ventilation. During treatment in the ICU, the patient underwent continuous renal replacement therapy (CRRT) for 48 hours. There were clinical improvements during CRRT, but his condition deteriorated after CRRT terminated. He died on the fifth day.
Discussion: Trauma is the main preventable cause of morbidity and mortality in adults. Sepsis can increase the risk of mortality in trauma cases. Insufficient identification of shock etiology and lack of follow-up in this patient led to suboptimal resuscitation up to MODS and death. Mechanical ventilation should be performed during initial resuscitation to reduce oxygen consumption.
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