Mom 64 ICU had a critical road crash
61F post-AVP polytrauma day 16 — ARDS + ICU delirium + pending ankle surgery — seeking advice on management
Background: 61-year-old female, no significant prior medical history. Admitted 14/04/2026 following a road traffic accident (AVP). Currently day 16 in ICU , Morocco.
Injuries identified on admission CT (body scanner):
Pneumoperitoneum + hemoperitoneum — 2 perforated intestines → operated day 2
C2 vertebral fracture with posterior displacement → neurosurgery: conservative management, collar removed day 4
Left pulmonary contusion + bilateral pleural effusion
Rib fractures: R1, R12, L4 anterior arc
Left renal cortical laceration Grade II + 14mm perirenal hematoma
Right adrenal hematoma 35mm
Left bi-malleolar fracture — awaiting surgery
Appendix 11mm with surrounding fat infiltration — managed conservatively
ICU course summary:
Intubated post-op, extubated day 6 — post-extubation respiratory failure, re-masked
Day 8: first seizure (no prior epilepsy history) — CT brain normal — started Keppra 500mg BD + Gardenal (now stopped by reanimator)
ARDS moderate (Berlin criteria): FiO2 peak 80%, PEEP peak 22, compliance nadir 12.9
Day 13: ICU delirium — visual hallucinations, physical restraints applied
Current status day 16 :
SpO2 97% — FiO2 50% — PEEP 5 — VNI weaning in progress
HR 86, RR 23, BP 138, temp 37.5
Spontaneous productive cough ×3 today
Conscious, communicates, psychologically improved with family presence
Pending issues / open questions:
Bi-malleolar fracture still untreated (day 16) — traumatologist plans locoregional anesthesia when respiratory status allows
Left renal laceration Grade II — no follow-up uroscanner done yet
Right adrenal hematoma 35mm — not reassessed since admission CT