Billy Goat Went Gruff: Case report on a blunt chest injury in a farmyard


Dr Saksham Gupta 

Case Report

A 63 year old male presented to our hospital after being pulled over onto his chest by a goat.  Computed-tomography revealed a large left extrapleural haematoma with active arterial haemorrhage. He had both ventilatory and circulatory derangements; traditional teaching would advise that his ‘B’ issues should be addressed before ‘C’. However, there was concern that decompressing the haematoma with a chest drain would release its tamponading effect, causing uncontrollable haemorrhage. A thoracotomy was also discussed, but this was considered risky as he was taking apixaban. The decision was made to accept his ventilatory compromise and to address the active bleeding with embolisation first. A thoracotomy was performed 12-hrs post emobolisation to clear the haematoma, allowing time for the apixaban to clear from his system. This case highlights how ATLS principles are a guide only and clinicians need to be proactive when the A-B-C framework may need to be modified.