Scenario-Based Approach
A 32-year-old man came to the emergency department (ED) for multiple trauma. He was found in a parking lot and was suspected to be fallen down from a nearby building. He was transferred to the ED by an emergency medical system with a cervical collar in pl
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Scenario-Based Approach Gil Joon Suh, Jae Hyuk Lee, Kyung Su Kim, Hui Jai Lee, and Joonghee Kim
7.1
Hypovolemic Shock Due to Multiple Trauma
A 32-year-old man came to the emergency department (ED) for multiple trauma. He was found in a parking lot and was suspected to be fallen down from a nearby building. He was transferred to the ED by an emergency medical system with a cervical collar in place and strapped to a backboard. He was confused and anxious, and could not remember the situation at the time of injury, but he was able to follow commands at the ED arrival. His initial vital signs were 55/45 mmHg–124 bpm– 22 cpm–32.6 °C with SpO2 at 96%. He was anxious G. J. Suh (*) Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea e-mail: [email protected] J. H. Lee · J. Kim Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea K. S. Kim Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea H. J. Lee Department of Emergency Medicine, Seoul Nation University—Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea e-mail: [email protected]
Q. Describe initial evaluation steps for this patient. A. Initial assessment of a multiple trauma patient (primary survey) must be performed promptly. The Advanced Trauma Life Support (ATLS) guideline provides an organized approach focused on identifying life-threatening conditions. It consisted of the following components (ABCDEs). Any problems identified should be managed immediately before moving on to the next step: 1. Airway maintenance with cervical spine protection: A. Ask the patient simple question. B. Observe the patient for signs of respiratory difficulty. C. Inspect oropharyngeal cavity. D. Assess the neck for injuries. E. Protect (immobilize) the C-spine. 2. Breathing and ventilation: A. Assess the adequacy of oxygenation and ventilation. B. Look for chest injuries. 3. Circulation with hemorrhage control: A. Check for bleeding and hemodynamic abnormalities. B. Secure IV lines and control bleeding. C. Reversal of anticoagulation.
© Springer Nature Singapore Pte Ltd. 2018 G. J. Suh (ed.), Essentials of Shock Management, https://doi.org/10.1007/978-981-10-5406-8_7
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4. Disability: A. Check for neurologic abnormalities. 5. Exposure/environmental control: A. Undress the patient and examine the entire body. B. Avoid hypothermia.
Q. Which category of hemorrhagic shock does the patient belongs to? What is your initial volume resuscitation strategy? A. Initial blood pressure of the patient was 55/45 mmHg and pulse rate was 124/ min, and he was anxious and confused. Therefore, it is class III hemorrhagic shock. Therefore, the patient needs blood transfusion as well as crystalloid infusion. The colloid solutions (dextran or albumin) have not been demonstrated to be superior to crystalloids. If there is no evidence of significant brain injury, the target systolic blood pressure should be 80–90 mmHg. Ho
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