alenka
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a 10 y.o. girl is involved in MVA,sustaining multiple injuries to her head,arms, and abdomen.Her BP is 90/60,ans pulse 120/min.her forearm is disfigured,and bone can be seen trough the wound.she is breathing periodically and has cyanotic lips.her abdomen is rigid,and ther's a flank discoloration.which of the following is the most appropriate next step in management?
A.splint the arm and cover wound with sterile gauze
B.administer crystalloid solution
C.administer vasopressins immidiately
D.packed RBCs
E.exploratory laparotomy
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| ARJ
Forum Guru
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B
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| phuluong2k
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Go to B too
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| winai
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B too
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| alenka
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yes,the answer is B.
but i'm a little puzzled-haven't they told us in Kaplan to stop the bleeding first and then-fluid resuscitation?i got this q wrong.....
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| drkpp
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i know thats a confusing topic but just go with your instinct and most of the times it works for me.... also he says that if the patient improves with fluids some preliminary investiigations can be done before exploratory lap. so that it can be well planned.
i dont know i still go by my own instinct
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| alenka
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just like in the jungle,huh?-always trust your instincts...
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| nisha
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Maybe administration of crystalloids through big bore I/V lines, foley catheter and administration of IV antibiotics are all done in preparation of imm exp lap for control of bleeding (like the first shock vignette pg 67 Kaplan)
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| chemamr
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i agree drkpp. B. Thatīs a nice avatar Nisha, just like yourself.
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| vbadalyan
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well i think the reason we do volume resusciation first is because the source of bleeding is not yet known.
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| winai
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what if the vassopressin is admin. instead or couple with crystalloid soln. ?
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