RTA with polytrauma injury

P. Snekapriya, N. Bhuvaneshwari

Department of clinical dietitian, Kauvery hospital, Cantonment, Tamil Nadu

Introduction

Road Traffic Accidents (RTAs), polytrauma refers to multiple traumatic injuries sustained by an individual, often involving several body regions or organ systems. Treatment of this condition is focused on early diagnosis and surgical intervention. In the report, we described a case of 28 Years old male who has no previously known co-morbidities. He had alleged history of RTA with Polytrauma injury.

Case Presentation

A 28-Year-Old male who has no previously known co-morbidities. He had alleged history of RTA with polytrauma injury on 17.03.2025.

History of loss of consciousness (+). Initially took to outside hospital, on17.03.2025 Patient referred to our hospital for further management.

On examination

Patient was hemodynamically stable.

CECT abdomen revealed grade IV renal injury and grade III liver injury.

CT face revealed left maxillary sinus fracture with multiple facial bone fractures.

Course in Hospital

20.03.2025: Patient became restless, tachypneic and impending respiratory failure for which he was intubated and mechanically ventilated. Patient developed ARDS, Sepsis (Burkholderia), AKI (Resolved), HAP (Hospital Acquired Pneumonia).

Blood investigation was done. (HB, platelets, sodium, potassium, RFT, LFT, albumin) are to be taken. In view of persistent fever spikes, repeat cultures were sent. Bronchoscopy was done, in view of low GCS, CT brain was done, which was normal study.

Prolonged ventilation needed tracheostomy. Tracheostomy was done.

01/04/2025: Patient was on sedation and paralysis.

Patient showed gradual improvement in GCS. Patients were slowly weaned to CPAP and BIPAP trial was given and shifted to ward on 27/04/2025. Decannulation was done. Oral feeds were initiated, and patient was slowly mobilized.

Discussion

Initially patient was on NPO for observation. Next day we started oral clear liquid diet. Patient became restless, tachypneic, he was intubated and mechanically ventilated. So, we started RT feeds (Clear liquid). Patient developed ARDS with high FiO2 requirement in which he was prone ventilated. Restarted the RT feed (Artificial supplement). Patient on MNS for Tracheostomy. We reduced the feeding due to the RFT elevation. Patient tolerated RT feeding, hence we increased calories and reduced protein content. Patient had loose stools and vomiting complaints, so feeding was withheld. As the patient condition improved patient was shifted to the ward, we added kitchen feed + supplement feed in the RT feed. Patient on NPO decannulation was done. We started oral trial (Normal liquids) patient tolerated well. RT feeding was stopped and given oral high protein semi solid diet along with oral nutrition supplement. The patient was advice to follow a high protein diet.

Conclusion

At discharge the patient was stable and advised to continue a high protein diet.

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