1. PATIENT INFORMATION
Age/Sex: 24-Year-Old Male
Date of Incident: 27 January 2026
Time of Injury: Approximately 4:00 PM
Mode of Injury: Tractor overturn accident (blunt abdominal injury)
2. HISTORY OF PRESENT ILLNESS
The patient was driving a tractor when he lost control of the vehicle, leading to overturning of the tractor over him. Heavy machinery was required to extricate the patient from beneath the vehicle.
He was brought to the Emergency Department at 8:30 PM in a gasping state.
On Arrival:
- Blood Pressure: Unrecordable
- Clinical Condition: Hemorrhagic shock
Immediate resuscitation was initiated as per advanced trauma protocol.
3. EMERGENCY MANAGEMENT
- Airway secured
- Aggressive fluid resuscitation initiated
- Hemodynamic stabilisation attempted
- Shifted urgently for CT imaging after initial stabilisation
4. RADIOLOGICAL FINDINGS
CT Head & Neck
- No Subdural Hematoma (SDH)
- No Epidural Hematoma (EDH)
- No major cranio-cervical injury
CT Abdomen
- Liver laceration
- Massive hemoperitoneum
- Pneumothorax
Diagnosis: Severe liver trauma with active intra-abdominal bleeding
The patient was shifted to ICU for further stabilisation.
5. MASSIVE TRANSFUSION PROTOCOL ACTIVATED
Blood products transfused:
- 4 Units PRBC
- 8 Units FFP
- 4 Units Platelets
- 4 Units Cryoprecipitate
Relatives were counselled regarding the critical condition and the need for emergency surgical intervention.
6. EMERGENCY SURGICAL INTERVENTION
After achieving relative hemodynamic stability, the patient was shifted to the operating theatre.
Intraoperative Findings:
- Approximately 3 liters of blood loss
- Major liver lacerations
Procedure Performed:
- ICD insertion for pneumothorax
- Exploratory laparotomy
- Pringle maneuver is applied to control hepatic inflow
- Identification of liver lacerations
- Hemostasis achieved
Duration of Surgery: Approximately 4.5 hours
7. POST-OPERATIVE ICU CARE
- Shifted to the ICU in an intubated state
- Mechanical ventilation support for 40 hours
- Continuous hemodynamic monitoring
- Gradual stabilisation
Extubation was successfully performed after clinical improvement.
8. ORTHOPAEDIC EVALUATION
Findings:
- Multiple rib fractures
- Left clavicle fracture
Management:
- Figure-of-8 brace applied for clavicle fracture
- Conservative management for rib fractures
- Pain management
- Respiratory physiotherapy
9. RECOVERY COURSE
- Gradual improvement in vital parameters
- Shifted from ICU to a private room
- Sequential removal of abdominal drains and intercostal drains as output reduced
- Regular wound dressing
- Mobilisation under supervision
10. DISCHARGE STATUS
- Hemodynamically stable
- Tolerating an oral diet
- Ambulating with support
- Discharged on oral medications
- Advised regular follow-up
CONCLUSION
This case highlights the advanced trauma care capabilities of Aster Aadhar Hospital, Kolhapur.
Key Strengths Demonstrated:
- 24/7 Emergency & Trauma Response
- Rapid Advanced CT Imaging
- Massive Transfusion Protocol Readiness
- Expert Hepatobiliary & Trauma Surgery
- Advanced Critical Care & Ventilator Support
- Multidisciplinary Orthopaedic Management
- Comprehensive Post-Operative Care
Through timely intervention, coordinated teamwork, and advanced medical infrastructure, a critically injured young patient was successfully treated and discharged in stable condition.
