Nagaretnam Bhasyani
Department of Emergency and Trauma, Hospital Sungai Buloh, Jalan Hospital, Petaling, Selangor, Malaysia.
Turk J Emerg Med. 2022 Apr 11;22(2):114-117. doi: 10.4103/2452-2473.342807. eCollection 2022 Apr-Jun.
Rectus sheath hematoma (RSH) is a life-threatening condition. Its pathology lies behind its unique anatomy. Critically ill COVID-19 patients are managed in the emergency department for longer periods while awaiting critical care admission. Therefore, more complex procedures such as prone positioning are performed in the emergency department to ensure patient care continues. We report this case of RSH in an intubated critically ill COVID-19 patient requiring prone position. During her stay in the Emergency Department Acute Care Unit, she developed anemia, uremia, and worsening hypoxia. Emergency contrast-enhanced computed tomography leads to our diagnosis of RSH. She was treated with a conservative approach and blood transfusion. We would like to highlight this case for its diagnostic complexity since this ventilated patient required both biochemical and radiological markers to diagnose RSH in combination with high suspicion levels. RSH must be considered in patients with risk factors such as prone position and anticoagulant usage. Last, a holistic approach to critically ill patients will not only benefit patients but also health-care profession. The direction of care should be decided based on the patient's condition, imaging, and hospital resources.
腹直肌鞘血肿（RSH）是一种危及生命的疾病。其病理与独特的解剖结构有关。危重症COVID-19患者在急诊科接受较长时间的治疗，同时等待重症监护病房的收治。因此，在急诊科会进行诸如俯卧位等更复杂的操作，以确保护理工作的持续进行。我们报告了一例需要俯卧位的插管危重症COVID-19患者发生RSH的病例。在她入住急诊科急性护理病房期间，出现了贫血、尿毒症和缺氧加重的情况。急诊增强计算机断层扫描使我们诊断出RSH。她接受了保守治疗和输血。我们想强调这个病例的诊断复杂性，因为这位使用呼吸机的患者需要结合生化和放射学指标，并高度怀疑才能诊断出RSH。对于有俯卧位和使用抗凝剂等危险因素的患者，必须考虑到RSH。最后，对危重症患者采取整体治疗方法不仅有利于患者，也有利于医疗保健行业。护理方向应根据患者的病情、影像学检查和医院资源来决定。
