Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma
ID: 278070 • Letter: C
Question
Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.
The following orders are written for the patient:
Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line
Obtain complete blood count, serum electrolytes
Oxygen at 2 L/min via nasal cannula
Type and cross for 4 units of blood
Flat plate of the abdomen STAT
(Learning Objectives 1, 4, and5)
Describe the pathophysiologic sequence of events seen with hypovolemic shock.
What are the major goals of medical management in this patient?
What is the rationale for placing two large-bore IVs?
What are advantages of using 0.9% NS in this patient?
What is the rationale for placing the patient in a modified Trendelenburg position?
Explanation / Answer
Answer. Part A: Phathosiologic sequence of events :
Major accident -->hurt in the abdomen --> bleeding from abdominal organs and digestive tract ---> internal bleeding ---> more than 20% blood loss --> low blood pressure 90/54.---.> heart is unable to pump enough blood to the body. --> body under shock ---- > hypovolemic shock because if blood plasma low
Part B: patient management :
1) lie the patient with their feet elevated about 12inches
2) keep the person warm to avoid hyperthermia
3) do not give fluid through mouth.
4) immediate CT scan ultrasound and ECG to be done
5) continuous measure of blood pressure pluse
Part 3:
Severe intravascular volume depletion due to fluid loss and heart shock. This fluid volume deficiency is acutely compensated by vasooccilation followed by hours of migration of fluid.
So two IVs were given.
Part 4- .9% NS solution also helps in compensation of blood loss and keeps the blood cells active and provides energy by ion exchange .
Part5:
In Trendelenburg position body is laid supine or flat on the back with feet higher than head by 15-30 degree.
Because of this position right ventricular outflow treat inferior to the right ventricular cavity causing the air to migrate superiorly into the position on right ventricle from which the air is less likely to embolize. It also gives the heart to collect back the de oxygenated blood easily. So the pumping become easier.