Pracovník převážel těžký náklad vysokozdvižným vozíkem. Při nepřehledné terénní situaci nezvládl řízení a vozík i s nákladem převrhl. Nebyl připoután bezpečnostními pásy, a proto se dostal oběma nohama pod vozík, který mu je svou vahou rozdrtil. Pracovník neztratil vědomí a křičel bolestí. Z vysokozdvižného vozíku navíc na něj vytekl hydraulický olej. Postižený byl okamžitě vyproštěn po nazdvižení vozíku mostovým jeřábem. Má amputovanou jednu nohu v oblasti bérce, druhá noha je rozdrcená od kolena dolů, všechna zranění jsou potřísněná hydraulickým olejem, z amputované nohy vystřikuje světlá krev, rozdrcená noha otéká a modrá. Pracovní diagnoza, léčba a směřování pacienta.
prac DG:polytrauma- amputace DK, crush + compartment syndrom, pravdepodobne i pocinajici hypovolemicky sok
lecba: zastava arterialniho krvaceni nejlepe aplikaci turniketu nad koleno na strane amputace, otekajici koncetinu ponechat kvuli podezreni na compartment syndrom volnou. Dale zalezi na primarnim vysetreni pacienta – zhodnoceni GSC a stupne soku a dychani (jina pridruzena traumata nejskou vyloucena): zajisteni zilniho vstupu + aplikace kysliku / ev intubace dle indikace, k tlumeni bolesti/intubaci ketamin + fentanyl, masivni volumoterapie kristaolidem 2000ml (a sledovani response na podany volum). Mezitim sterilni kryti pahylu a zajisteni amputatu zajisteni druheho zilniho vstupu, dasli eventuality dle situace jako stiffneckcollar, druhotne ohledani, natriumbicarbonatby bylo moznei na slepo zvazit (acidoza a crush syndrom)…. preklad na traumacentrum.


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