Question

Please help to answer these question below

1. Identify one intervention that is needed to ensure patient safety in patient with Trauma and Liver Failure
2. Identify one assessment that is needed to ensure patient safety during patient with Trauma and Liver Failure
3. List one complication seen in a diabetic wound
4. List one complication seen in a venous status wound
5. List one complication seen in an arterial wound

Answer 1

1. Intervention that is needed to ensure patient safety in patient with Trauma and Liver Failure
   Basically intervention which is done in trauma and liver injury depends upon the grade of the liver injury in trauma.
   
   let us first talk about the Liver Injury Scale:

   Grade	Injury	Description
   I	Haematoma Laceration	subcapsular haematoma<10% of surface area Capsular tear, <1cm parenchymal depth
   II	Haematoma Laceration	Subcapsular, 10-50% surface area, intraparenchymal extension <10cm <10cm long, 1-3cm parenchymal depth
   III	Haematoma Laceration	Subcapsular, >50% surface area, intraparenchymal extension >10cm >3cm intraparenchymal depth
   IV	Laceration	Parenchymal disruption of 1-3 Couinaud's segments within a single lobe
   V	Laceration Vascular	Parenchymal disruption >3 Couinaud's segments within a single lobe Retrohepatic vena cava/ central major hepatic veins
   VI	Vascular	Hepatic avulsion

   Interventions:-
   1. Simple lacerations which are not bleeding at laparotomy: A drain is kept in the liver bed, blood and clots are sucked out and peritoneal wash is given.
   2. Simple laceration with bleeding: It is sutured by interlocking horizontal mattress sutures by using special liver suturing needle. If too much tension is applied while suturing, cutting through can occur. Omentum can be used as a Plugin between the laceration. Absorbable sutures are used.
   3. Subcapsular haematoma: If present should be evacuated.
   4. Deep laceration with bleeding: In such situations, the wound should be opened. Dead liver parenchyma is removed, bleeding vessel at depth and biliary radicle are ligated. It is described as tractotomy.
   5. Severe lacerations: These injuries present with massive bleeding. Temporary control is obtained by compression of the portal vein and hepatic artery in gastrohepatic omentum in front of the foramen of Winslow (Pringle manoeuvre). If bleeding stops, portal veins or branches of the hepatic artery are damaged. If bleeding continues, hepatic veins are the source of bleeding. Visualisation of source of bleeding with debridement of avascular liver tissue is done by finger fracture method. Perihepatic packing can be used to compress the liver as a temporary measure to buy time for resuscitation, to explore the rest of the abdomen or as a definitive treatment when other measures fail. Pack is usually removed after 24-48 hours.
   6. Complex liver injuries: These injuries involve hepatic veins, retrohepatic vena cava or branches of portal vein resulting in massive haemorrhage. This type of massive injury can be managed by a large thoracoabdominal incision or abdominosternal incision by doing sternotomy. Division of the right triangular ligament helps in visualising bleeding from hepatic veins.

2. Assessments that are needed to ensure patient safety during patient with Trauma and Liver Failure:-
   A. Complete blood count, coagulation studies, grouping and cross-matching. Fall in haemoglobin is an indication of ongoing haemorrhage-especially while managing a patient with liver/splenic injury on the conservative line of management.
   B. Serum electrolyte analysis
   C. Serum amylase/lipase
   • May be elevated because of pancreatic ischaemia due to hypotension
   • Persistent elevation may be an indication of intraabdominal injury.
   D. Plain X-rays
   • Chest X-ray: Pneumoperitoneum-fundic, stomach (air bubble in the thorax as in diaphragmatic injury, retroperitoneal air-duodenal perforation.
   • Pelvic fractures
   E. Role of ultrasound
   FAST: Focussed assessment with sonography for trauma
   F.  Diagnostic peritoneal lavage (DPL)
   G. CT scan
   H. Diagnostic laparoscopy

3. Complication seen in a diabetic wound:-
   A. Following an injury or due to infection, an ulcer develops along with swelling and oedema of the leg-Stage of cellulitis.
   B. Cellulitis stage takes up a virulent course, spreads deeper and also upwards along fascia! planes-Stage of spreading cellulitis.
   C. Secondary infection caused by mixed organisms along with anaerobes and nonclostridial gas-forming organisms produce multiple abscesses-Stage of abscesses.
   D. Tense oedema along with vascular compromise which is already existing produces ischaemia and gangrenous patches of skin, toes, etc.-Stage of gangrene.
   E. Infection involves deeper tissues such as bone, producing osteomyelitis-Stage of osteomyelitis.
   F. Untreated cases develop rapidly spreading cellulitis and gangrene of the limb producing septicaemia and diabetic ketoacidosis-Stage of septicaemia

4. one complication seen in a venous status wound:-
   Venous Ulcer is also known as Gravitational ulcer

5. one complication seen in an arterial wound:-
   Infection and tissue necrosis

This is how we can explain all the answers.
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