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Author34 Posts
  #1

A 43-year-old female is rescued from a car accident site. On arrival to the emergency room she has T: 95.6 F; PR: 150/min; RR: 24/min; BP: 70/0 mm Hg and JVP: 0 cm H2O. She is shivering and perspiring profusely. On abdominal examination she has mild distention but not tenderness. On further examination she also has a scalp laceration but no other signs of external bleeding. Her chest x-ray, x-ray of pelvis and x-ray of extremities are normal. Her airway is secured and she is given rapid intravenous isotonic fluid but she remains hypotensive. What would be the next step in management of this patient?


A. Do a diagnostic peritoneal lavage
B. Do a CT scan of abdomen
C. Do an exploratory laparotomy
D. Do a MRI of abdomen
E. Do a CT scan of head





  #2

c - explorotory laparotomy
Intracranial bleeding could not lead to massive blood loss like we see here, so can't be E... the patient is unstable and needs emergent care so rule out A, D, B


  #3

it can be A. Do a diagnostic peritoneal lavage it tells us rapidly if theres blood in peritoneum or not...which is all thats needed to preceed to laprotomy.


  #4

wel DPL wil only diagnose this condition, whereas laprotomy will be a therapeutic approach , we will not win by simply sorting out the cause of (impending) death we need to cure her and with such a situation where every second counts we shd not waste time in just diagnosing it , our approach shd be therapeutic..


  #5

there is no external bleeding, no signs of peritoneal irritation, and there is a possibility that she is bleeding elsewhere like pelvis. dpl can help us rule out intraabdominal bleeding.


  #6

car accident most likely rupture of the spleen. She did not fall to be suspicious of pelvis fracture. I think is C.


  #7

I think the answer is C.

pelvis was normal on XRs, so most likely source is abdominal, they could've done an abdom U/S or a CT if easily available and you don't lose much time doing it, but with this pt with these VS, not responding to IV fluids, I'd go for surgery.



  #8

What right answer ? Robin


  #9

i will go with A-----DPL will not take much time


  #10

Answer is A as Sarika 's explannation.


  #11

In acute abdomen we go straigth to explore laparotomy even without the definite diagnosis because it is obvious that the pathology is there. in this case,it is only a hint that an intra abodominal bleeding is the cause of shock,patient being unstable, we can do DPL in the Or or ER simultaneous with resuscitation, then laparotomy.


  #12

This patient remains hypotensive even with fluid resuscitation, so I would choose an exploratory laparotomy.
You can't do a DPL with such an instable patient: it would be a waste of time and the patient could die!


  #13

Agree, C! Laparotomy for unstable patient.


  #14

c


  #15

major loss of bloodloss can occur either in the abdomen pelvis and lungs , lugs is ruled ou witha normal chest x ray
now we need to see if its frm abd or pelvis
soo doing a dpl would tell usif thereis bleeding in the abdomn soo its better we proceed that way



  #16

But blood pressure is 70/0. This is a sign of hypovolemia, a abdominal laparotomy will locate and solve the problem right away


  #17

answer is C.
Indication for peritoneal lavage is a stable patient with abdominal pain. Prep for lavage will kill this patient


  #18

controversial, but maybe the best option and sort of consensus is surgery right away.

qbanks aren't always correct.


  #19

where is this question from?


  #20

C is the answer pals






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