Blood Everywhere: A Case Study in Blood An ambulance arrives at the scene of an
ID: 226404 • Letter: B
Question
Blood Everywhere: A Case Study in Blood An ambulance arrives at the scene of an automobile accident, having been summoned by an in-vehicle security system. What the emergency personnel find is like a scene from a horror film. Maggie Silvers, the apparent driver of the car, is sitting, slumped next to the vehicle, with blood covering her shirt and hands. Her car has clearly hit a tree: a branch is sticking into the driver’s window, and the airbag has been deployed. Maggie looks dazed, and as the paramedics approach she says with a mixture of panic and relief, “There’s blood everywhere!” Maggie is only semi-lucid as she babbles on about pushing out the broken glass in her car window. Maggie, a 48-year-old woman, is, indeed, bleeding profusely from multiple left-arm cuts and an especially deep laceration on her left upper arm. The paramedics stop the bleeding and move her quickly to the ambulance, after noting no other apparent injury. Her systolic blood pressure is 80 mm Hg (low), and her diastolic is not audible (too low to hear). Her heart rate is 122 bpm (very rapid), and her skin is pale and clammy, indicating peripheral vasoconstriction (narrowing of her blood vessels, particularly in the skin) and circulatory shock-like signs. On the way to the hospital, a paramedic begins transfusing normal saline solution (NSS; water with some NaCl, similar to body fluids, given directly into her vein). A fast hematocrit (HCT) test upon Maggie’s arrival to the emergency department (ED) indicates that her HCT is low, but normal. Several vials of Maggie’s blood are also sent to the lab for blood tests and typing. Two liters of NSS are transfused over the next hour while the ED physician sutures her deepest, left-upper-arm laceration. Despite no further bleeding since the paramedics treated her at the scene, Maggie’s next HCT, tested one hour after the original HCT, drops to below normal. Aside from her present health problem, Maggie is otherwise healthy. She is admitted to the hospital for overnight observation.Blood Everywhere: A Case Study in Blood An ambulance arrives at the scene of an automobile accident, having been summoned by an in-vehicle security system. What the emergency personnel find is like a scene from a horror film. Maggie Silvers, the apparent driver of the car, is sitting, slumped next to the vehicle, with blood covering her shirt and hands. Her car has clearly hit a tree: a branch is sticking into the driver’s window, and the airbag has been deployed. Maggie looks dazed, and as the paramedics approach she says with a mixture of panic and relief, “There’s blood everywhere!” Maggie is only semi-lucid as she babbles on about pushing out the broken glass in her car window. Maggie, a 48-year-old woman, is, indeed, bleeding profusely from multiple left-arm cuts and an especially deep laceration on her left upper arm. The paramedics stop the bleeding and move her quickly to the ambulance, after noting no other apparent injury. Her systolic blood pressure is 80 mm Hg (low), and her diastolic is not audible (too low to hear). Her heart rate is 122 bpm (very rapid), and her skin is pale and clammy, indicating peripheral vasoconstriction (narrowing of her blood vessels, particularly in the skin) and circulatory shock-like signs. On the way to the hospital, a paramedic begins transfusing normal saline solution (NSS; water with some NaCl, similar to body fluids, given directly into her vein). A fast hematocrit (HCT) test upon Maggie’s arrival to the emergency department (ED) indicates that her HCT is low, but normal. Several vials of Maggie’s blood are also sent to the lab for blood tests and typing. Two liters of NSS are transfused over the next hour while the ED physician sutures her deepest, left-upper-arm laceration. Despite no further bleeding since the paramedics treated her at the scene, Maggie’s next HCT, tested one hour after the original HCT, drops to below normal. Aside from her present health problem, Maggie is otherwise healthy. She is admitted to the hospital for overnight observation.
Question 1 Normal Saline is: __________________________. hypertonic hypotonic isotonic none of these
Question 2 In the emergency room, blood is withdrawn from the vein and into a test tube. The packed cell volume (RBCs) is 1.45, and the plasma volume is 3.55 ml. Calculate Maggie's hematocrit in the ER. 15% 29% 34% 36%
Question 3 In the case study, the paramedics infuse ___________________________, instead of giving Maggie a blood transfusion.
Question 4 Maggie's circumstances would be much better if she was taking a prescribed ACE inhibitor. True False
5 Maggie's body is releasing more renin as a result of her drop in blood pressure. True False
Question 6 Maggie's body is likely to decrease the release of erythropietin as a result of her accident. True False
Question 7 Assume for a moment that ambulances carry blood for purposes of transfusion. What blood type would you expect to be in greatest supply in an ambulance? Don't include an Rh factor in your answer.
Question 8 Aside from the measurement of hematocrit, the ER physician should probably order the measurement of _____________________________ to determine Maggie's oxygen carrying capacity.
Question 9 Because Maggie received 2 liters of normal saline in the emergency room, you would expect her hematocrit to increase. True False
Question 10 Maggie's body is decreasing the amount of antiduretic hormone (ADH) being produced. True False
Explanation / Answer
1. Normal Saline is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment. It contains no antimicrobial agents. and the pH is 5.0 (4.5 to 7. It contains 9 g/L Sodium Chloride with an osmolarity of 308 mOsmol/L. It contains 154 mEq/L Sodium and Chloride. It is an isotonic solution.
So, the option C is correct.
2. The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly.
So,the hematocrit value= packed cell volume (RBCs)/ total blood volume *100
= 1.5/5*100
29 %
So the second option is correct.
3. The paramedics infuse normalsaline solution, i.e. water with NaCl
4. false. Since the ACE inhibitor cannot be given without proper diagnosis. In this case only emergency medicines can be given till further diagnosis or after knowing the patient medical history.
5. Renin activates the renin-angiotensin system by cleaving angiotensinogen, produced by the liver, to yield angiotensin I, which is further converted into angiotensin II by ACE, the angiotensin-converting enzyme primarily within the capillaries of the lungs. Angiotensin II then constricts blood vessels, increases the secretion of ADH and aldosterone, and stimulates the hypothalamus to activate the thirst reflex, each leading to an increase in blood pressure. Renin's primary function is therefore to eventually cause an increase in blood pressure, leading to restoration of perfusion pressure in the kidneys. Therefore more renin would be released in order to increase blood pressure.
So it is true
6. Yes it is true that erythropoietin level would decrease in case of accidental patient
7. B+ blood type is very common among people. So it should be carried in ambulances if possible.
8. measurement of hemoglobin oxygen carrying capacity
9. if saline or other fluids are being supplied, the blood sample would be diluted and the hematocrit will be artificially low.
So, the statemen is false.
10. ADH is also called arginine vasopressin. It’s a hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells your kidneys how much water to conserve.
ADH constantly regulates and balances the amount of water in your blood. Higher water concentration increases the volume and pressure of your blood. Osmotic sensors and baroreceptors work with ADH to maintain water metabolism.
Since the body of patient is not able to conserve water, so wecan say the hormone ADH level is decreased.
so, it is true.