RESUMO
La ecografía ha demostrado tener un papel determinante en el diagnóstico y pronóstico del tratamiento de los pacientes con politrauma. Describimos el caso de un hombre de 52 años politraumatizado y hemodinámicamente inestable. La evaluación ecográfica abdominal fue positiva para hemoperitoneo, por lo que se realizó una laparotomía exploratoria de urgencia. En el período intraoperatorio, se utilizó la ecografía pulmonar para excluir lesión pulmonar traumática. En el pulmón derecho, la ecografía pulmonar sugirió presencia de neumotórax y en el pulmón izquierdo, consolidación subpleural. Posteriormente se realizó una tomografía computarizada que confirmó los hallazgos ecográficos. Al cuarto día del ingreso se le realizó una corrección quirúrgica de fractura compleja izquierda de cadera, con un bloqueo cuadrado lumbar tipo 2 guiado por ecografía antes de la incisión quirúrgica. El procedimiento transcurrió sin incidentes y el paciente permaneció hemodinámicamente estable, sin signos indirectos de dolor. Este caso ilustra que el examen guiado por ecografía puede tener un papel crucial en el manejo de los pacientes politraumatizados. Fue una herramienta de diagnóstico fundamental en la evaluación inicial, así como en la gestión posterior en quirófano
Ultrasound has an important role in the diagnosis and prognosis of polytrauma patients. We describe a case of a 52-year-old man with hemodynamic instability and multiple injuries. Abdominal ultrasound evaluation was positive for hemoperitoneum, so an exploratory laparotomy was performed. During the intraoperative period, lung ultrasound was used to exclude traumatic lung injury. In the right lung, lung ultrasound suggested the presence of pneumothorax, and in the left a subpleural consolidation. Subsequently, a computed tomography was performed, confirming the sonographic findings. On the fourth admission day, he underwent surgical correction of a left hip fracture. A type 2 quadratus lumborum block (ultrasound-guided) was performed before surgical incision. The procedure was uneventful. The patient remained hemodynamically stable, without indirect signs of pain. This case shows that ultrasound-guided examination plays a crucial role in the management of polytrauma patients. It was a fundamental diagnostic tool in the initial evaluation, and was also used during surgery
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Anestesia por Condução/métodos , Ultrassonografia/métodos , Hemoperitônio/cirurgia , Plexo Lombossacral , Laparotomia/métodos , Tratamento de Emergência/métodos , Bloqueio Nervoso/métodos , Traumatismo Múltiplo/cirurgiaRESUMO
Ultrasound has an important role in the diagnosis and prognosis of polytrauma patients. We describe a case of a 52-year-old man with hemodynamic instability and multiple injuries. Abdominal ultrasound evaluation was positive for hemoperitoneum, so an exploratory laparotomy was performed. During the intraoperative period, lung ultrasound was used to exclude traumatic lung injury. In the right lung, lung ultrasound suggested the presence of pneumothorax, and in the left a subpleural consolidation. Subsequently, a computed tomography was performed, confirming the sonographic findings. On the fourth admission day, he underwent surgical correction of a left hip fracture. A type 2 quadratus lumborum block (ultrasound-guided) was performed before surgical incision. The procedure was uneventful. The patient remained hemodynamically stable, without indirect signs of pain. This case shows that ultrasound-guided examination plays a crucial role in the management of polytrauma patients. It was a fundamental diagnostic tool in the initial evaluation, and was also used during surgery.
