The patient was a 64 f with unknown PMH who was brought into the ER in the middle of the night after being struck by an auto at unknown speed. The driver of the car then got out and tried to kill her so she couldn’t tell anyone. We didn’t hear about her until the next day. I walked into the ED in the morning and found her altered, hypoxic to the 80s on 5L NC, and anuric.
Known injuries: facial lacerations, fractured R ulna, huge laceration, partial degloving of R fore-arm, open book pelvic fracture.
CT brain normal, CT c-spine normal, supine CXR poor quality, difficult to read, suggesting of L deep sulcus.
Bolused her for the UOP, Norweigian trauma surg attending had just had her CT CAP and came to me to say that she had huge B/L PTX (lesson: don’t trust your supine trauma films). B/L chest tubes placed with improvement of sats to high 90s. UOP picked up after fluids.
Patient did ok after that, Andrew had to put 48 stitches in her arm. Unfortunately she was an elderly woman with severe injuries at a hospital with limited resources. At last update from Andrew (still there) she had a bad ileus and appeared to be in septic shock.
Trauma is a big problem in Addis. The people walk in the street, there are no traffic lights, and the taxis are truly nuts. On one of my first nights we got in a cab and I asked if there was a seatbelt for the front seat passenger. The cabbie laughed and said “in Addis only drivers get seat belts!.”