Age: 62.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Wound closure
Clinical narrative: History of Present Illness:  Patient is a 63-year-old male presenting as a level 2 trauma activation.  He is transfer from a local hospital.  He was driving his motorcycle approximately 25 to 30 miles an hour when he rear-ended his brother-in-law, striking the steering column and being thrown onto his left side.  He sustained a left elbow laceration which underwent primary repair with facility.  He is complaining of severe groin pain as well as chest wall discomfort.  Prior to the injury he was independently ambulatory without assistive devices and denies any history of previous groin or pelvic surgeries.  He is right-hand dominant.  He is complaining of some mild pain in his right elbow as well.  He was unable to ambulate after the accident..  He denies any numbness or tingling in his legs.  He denies any personal or family history of DVT, PE, problems with anesthesia.  He is retired.  Lives in Perryville, MO.    Assessment and Plan: Patient is a 63-year-old male with APC 2 pelvic ring injury and extraperitoneal bladder rupture, as well as left arm road rash and right elbow pain/limited motion   Discussed with patient his brother natural history and treatment options for unstable left pelvic ring injury with evidence of anterior disruption more than 2.5 cm and some suggestion of left SI instability as well as well as associated bladder rupture.  Multidisciplinary conversation held with Dr of urology and Dr of trauma in formulation of treatment plan..  We discussed treatment options including nonoperative management, external fixation, as well as open reduction internal fixation.  Discussed my plan would be to start with an exam under anesthesia.  Given his age, obese status, would not recommend an external fixator.  If there is evidence of complete disruption of the sacroiliac ligaments, he will require associated posterior fixation as well.  After exam under anesthesia is complete, we will plan to proceed with combined open reduction internal fixation of the anterior pubic diastases as well as displaced superior pubic ramus fracture with combined repair of extraperitoneal bladder injury to be performed by urology.  Additional posterior fixation would be dictated by instability based off preoperative exam.  We discussed risks of surgery including bleeding, infection, nonunion,, damage to local structures including lumbosacral nerve roots, sexual dysfunction including erectile dysfunction dyspareunia which are noted to be significantly increased with this pattern of injury regardless of treatment option, chronic pain, DVT, PE, intraoperative cardiopulmonary event, recurrent bladder rupture..  After discussion of risks and benefits, patient agrees to proceed with surgical intervention.  We discussed that right lower extremity weightbearing status will be dictated by exam under anesthesia instability after fixation   1. Weight bearing status: Bedrest until the OR.  Weightbearing as tolerated bilateral upper extremities for now.  Continue to monitor right upper extremity pain and motion with consideration of CT to evaluate for occult fracture if persistent limitation of motion 2. Anticoagulation Recommendations: Started on Lovenox within 24 hours of mission.  Plan to hold a.m. dose with planned open pelvic surgery tomorrow 3. Antibiotic Recommendations: We will plan for perioperative Ancef less than 24 hours.  May consider additional duration given traumatic bladder disruption if indwelling Foley are required.  4. N.p.o. past midnight.  Plan for exam under anesthesia, open reduction internal fixation of anterior pelvic ring as well as possible posterior fixation tomorrow in conjunction with open bladder repair    INCIDENTAL FINDING OF COVID POSITIVE ON  8/31/2021  PATIENT STILL HOSPITALIZED AT THE TIME OF REPORT