Morbidity and Mortality Conference 2



KEY WORDS 关键词



Disseminated intravascular coagulation 弥散性血管内凝血， rim subdural hematoma 边硬膜下血肿, decompressive craniectomy 去骨瓣减压, sagittal sinus 矢状窦, tissue plasminogen activator 组织型纤溶酶原激活物, fibrin degradation products 纤维蛋白降解产物, “INR”，herniation 疝, edema 水肿, oozing 渗血, surgical cellulose 外科纤维素, gelfoam 明胶海绵, hemostatic agents 止血剂, coagulopathy 凝血功能障碍



TEXT 课文



9 yo fell 20 feet.  GCS = 5.  Left pupil fixed and dilated.  Intubated.  CT head showed an acute left sided rim subdural hematoma with midline shift greater than the thickness of the subdural hematoma. Large fracture across the midline probably involving the sagittal sinus.  Taken to the operating room for emergency decompression.

Large right side frontal fracture.  On incising dura, brain was non-pulsatile, herniated through the bone defect.  Hemostasis complicated by sagittal sinus injury. INR intraop was 1.84.  Refractory edema.  Hemostasis achieved with gelfoam and surgicel.  Drain placed. Coagulopathy thought to be due to tissue factor release. 

On arrival ICU bilaterally fixed and dilated.  Became bradycardic and died.



9哟下跌了20英尺。熙= 5。左瞳孔固定和扩张。插管。脑部CT显示有中线移位比硬膜下血肿厚度更大的一种急性硬膜下血肿，左边缘片面。大断裂可能涉及跨矢状窦中线。送往手术室紧急减压。

大型右侧额叶骨折。在切开硬脑膜，脑，非搏动性，通过骨缺损突出。止血夊杂损伤矢状窦。印度卢比intraop为1.84。难治性水肿。实现与明胶海绵止血surgicel。排水管上。凝血认为是由于组织因子的释放。

在抵达加护病房双边固定和扩张。成为心动过缓和死亡。