What's Your Diagnosis?

“Trauma Patient” … Case Conclusion November 7, 2011

The Conclusion Is…

This patient was in hemorrhagic shock with hemoperitoneum. The MTP was activated, and the patient was given a dose of TXA. Surgical consultation was delayed by a prior patient. Blood products were brought to the bedside, and crystalloid administration was strictly limited. The patient’s blood pressure remained steady around 80/50 mm Hg, and he continued to be alert, with good peripheral pulses. Initial labs came back and showed a normal hemoglobin, but elevated PT. Two units of PRBCs and 2 units of FFP were transfused through a fluid warmer. These brought the patient’s blood pressure up to 100/60 mm Hg and heart rate down to 100 beats per minute. The patient remained stable until surgical consultation arrived. Because of his demonstrated stability, he underwent a CT scan, which showed a grade 3 liver injury with a blush. He was taken to the angiography suite and his liver injury was embolized. The patient was monitored in the ICU and did well, never requiring an operation. He was discharged home after 1 week in the hospital.

Congratulations to Dr. Anthony, Dr. Ebeid, Dr. Mbinga, Dr. Park, and Dr. Salah — this week’s winners of Emergency Medicine Practice’s “Traumatic Hemorrhagic Shock: Advances In Fluid Management!” For an evidence-based review of the treatment of critically injured patients in hemorrhagic shock, read this issue.