Polytrauma with severe traumatic brain injury: Case report

Abstract

The management of polytrauma patients requires a multidisciplinary approach, usually realised by a trauma team, based on trauma protocols. This category of patients should be treated in trauma centers, which are hospitals with extensive human and infrastructure resources. The authors present the case of a 17 years old female, a car accident victim, successfully treated in Iasi Neurosurgery Hospital. As our hospital did not fulfill the requirements of a trauma center, the patient was managed in cooperation with various specialists from other hospitals. After the secondary survey, the patient presented severe traumatic brain injury (Glasgow Coma Scale 5), double fracture of the mandibula, left pulmonary contusion, grade I spleen injury, fracture of the left clavicle and left radius bone, having an injury severity score of 29. During the Neurointensive Care Unit hospitalization, the patient was submitted to multiple neurosurgical interventions. She was mechanically ventilated for 10 days, with complications during the evolution such as acute respiratoy distress syndrome, bacterial meningitis and severe sepsis with hospital aquired microorganisms. During the stay in ICU, after an alternating but eventually positive evolution, the rehabilitation therapy was instituted. At discharge, after a lenght of stay (LOS) of 69 days, the patient was alert and awake with sensory aphasia and right hemiparesis and was referred to a neurologic rehabilitation clinic.