MANAGEMENT OF ARDS IN A POLYTRAUMA PATIENT
Abstract
This was a case of polytrauma involving
musculoskeletal system and lungs. During
initialevaluation lung contusion was
not evident. As the injury worsened patient
became hypoxic whichmanifested
as low saturation and irritability in the
post operative period. Associated hypotension
couldhave aggravated the
cerebral ischemia. Patient was diagnosed
as having ARDS by clinical,
biochemical and radiological findings.
Onset of ARDS following the lung injury,
complicated thecondition further. HIE
was diagnosed by neurophysician. Cerebral
ischemia in this case, probablyresulted
from primary lung injury, ARDS
and hypotension. Presence of long bone
fracture explainsthe hypotension.
Inotrope support was given along
with aggressive volume resuscitation
with bloodand crystalloids. There was
improvement in the hemodynamic status.
Lung protective ventilationstrategy was
followed to manage ARDS. CVP guided
fluid therapy was given. Glycemic
control wasmaintained. Gradual improvement
in lung injury and oxygenation was
indicated by clinical examination, ABG
analysis and serial chest X-ray. Though
cerebral ischemia took sometime for recovery
, it was almost a complete one.
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