Index Title: RROQUE’s Medical anecdotal Report [04-2]

MAR Title: Indecisiveness in the face of Disaster

Date of Medical Observation: May 5, 2004

Narration:

            A regular day it was on the 4^th of May 2004, as I was doing my routine activities in the department of Surgery of Ospital ng Maynila. My heart started thumping as Code Yellow was sounded by the disaster control coordinator in the Trauma ER. We had just received a vehicular accident occurred in the Diosdado Macapagal Highway minutes away from our trauma unit. A public utility bus carrying a ton of passengers bound south for a company outing swerved and lost control and collided head on to a private north bound van, smashing and pinning the driver dead on the spot. An exodus of thirteen multiply injured patients found the entrance of our trauma ER.

            A 44 year old female was received stretcher borne sustaining multiple fractures, a comminuted fracture of the left femur, complete impacted fracture of the right radius and a badly bruised left thorax.

            During the 6 hour course in the ER, after a volley of lab exams and lengthy x-ray process, patient had episodes of hypotension notwithstanding the belligerent fluid resuscitation efforts we have infused. Secondary survey showed a progressive tenderness of the left upper quadrant with brief periods of unexplained hypotension. The department chair took cognizant of the problem and ordered patient to be directed to the OR. A ruptured spleen was noted bleeding and was the reason for the mysterious hypotension.

Insights (discovery, stimulus, REINFORCEMENT):

            Every surgeon is faced with overwhelming tasks amidst the many victims of disaster. A multiply injured trauma patient will not present a pattern of signs and symptoms that is readily identifiable. A misleading factor in diagnosis, often not recognized is the trivial injuries of ruptured abdominal organ or viscera. A systematic and prompt secondary survey is constantly in order to raise the index of suspicion so as to avoid diagnostic errors.  In contrast, we will not err on the decision to open all baffling abdominal traumas in search for the unaccounted bleeding.