Mistake in diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare co-existance of disease or pathology
Reza Safaeian, Valiollah Hassani, Hamid Reza Faiz
(Department of Anesthesiology, Rasoul Akram Medical Complex Affiliated with Iran University of Medical Sciences, Tehran, Iran)
Am J Case Rep 2016; 17:646-649
Diaphragmatic rupture can be seen in up to 5% of car accidents, and 80%-100% of diaphragmatic hernias are associated with other vital organ injuries. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic managements.
CASE REPORT: A 37-year-old male victim of a head-on collision who was suffering diaphragmatic rupture and corneal laceration was prepared for an emergency operation 11 hours after the car accident. Gastric decompression, pre-oxygenation, rapid sequence induction with succinylcholine, immediate use of non-depolarizing muscle relaxant, and mechanical ventilation with low tidal volume after intubation were used in anesthetic management of the patient.
CONCLUSIONS: Because of the high prevalence of coexisting pathologies with traumatic diaphragmatic hernia, anesthetic management must be tailored to the associated pathologies.
Keywords: Anesthesia, Adult, Corneal Injuries - surgery, Hernia, Diaphragmatic, Traumatic - surgery, Humans, Lacerations - surgery, Male, Multiple Trauma - surgery