Soft tissue compartment bleed—the iceberg phenomenon: a case report

Author:

Vaidyanathan Ramesh1,Dar Parvez Mohi Ud Din2,Bagaria Dinesh1,Gupta Amit1

Affiliation:

1. Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India

2. Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India.

Abstract

Abstract Introduction Hemorrhage control is the essence of trauma care. Conventional teaching is 1 on the floor (ie, external bleeding) and 4 more (thoracic cavity, abdomen, retroperitoneum, and long bones). In this case report, we present a unique case with concealed bleeding into the soft tissue compartment leading to shock. This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock. Case presentation We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management. On presentation, he had a pulse rate of 117 beats/min, a blood pressure of 90/60 mmHg, and a Glasgow Coma Scale (GCS) score of 9. During resuscitation, the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15. He was then intubated and reevaluated. Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall, extending up to the right lumbar region. Conclusion We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients, which should not be overlooked after having ruled out the other 5 sites.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Emergency Medicine,Critical Care and Intensive Care Medicine

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