Internal Bleeding Management in Patient with Blunt Abdominal Trauma at Rural Hospital: A Case Report of 40-Year-Old Male with Spleen Rupture

Background
 Abdominal injury caused by blunt trauma is a common presentation in the emergency room.[1] Especially developing countries like Indonesia, number of motor vehicle accident public roads still high. Eighty percent traumatic with majority deaths are hypovolemic shock.[2]
 Case description
 A 43-years-old man arrived at room after motorcycle 2 hours before. AMPLE and primary survey was conducted: clear airway, spontaneous breathing, BP 70/palpation mmHg, HR 123 times per minutes altered consciousness which showed patient undergoing hemorrhagic shock. The hemodynamically stable given 1 liter normal saline through two intravenous line. FAST conducted, intraperitoneal free fluid seen Morison’s pouch, left hemithorax, pouch Douglass. Chest X-Ray fracture ribs 7, 8, 9 lateral aspect minimal hemothorax. After supporting examination performed, patient’s dropped to 60/40 “transient responder”, indicating should undergo laparotomy. 500mL colloid systolic target 80 – 90 mmHg accordance permissive hypotension theory. ±1500ml blood found inside abdomen during operation, splenic rupture grade V cause. In fifth day surgery, discharged.
 Conclusion
 Since abdominal could cause bleeding that leads shock, therefore immediate diagnosis needed.[1] Multiple management rural hospital be concordant ATLS Schwartz’s Principles Surgery.