DrVirgo
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A 34 year old man is brought to the ED 3 hours after being involved in a MVA. He is not oriented to time or place an dis very combative. He cannot give relevant answers during his history taking. His temp is 96.9F, BP is 40/0 mmHg, Pulse is 130/min, and Resp: 30/min. Exam shoes that an antero-posterior chest compression seems to be painful, heart sounds ar emuffled, and breathing sounds are normal. His abdomen is destended and abdominal palpation is obviously painful. He has no JVD. Physical examination otherwise shows no abnormalities. Lab studies are pending. A cervical collar is placed. A central venous line is placed because his peripheral veins are collapsed and virtually not accessible. Lactated Ringer infusion is started. Which of the following is the most appropriate next step in management?
A. Pericardial puncture
B. Diagnostic peritoneal lavage
C. AP, lateral and open mouth neck X-Ray
D. CXR
E. Laparoscopy
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| robin082006
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D. CXR
chest trauma+chest pain+hypotension+muffled heart sound-->suspect aortic rupture-->look for widened mediastinum on CXR
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| DrVirgo
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Answer: B.
This is a case of hemorrhagic shock... maybe due to a reptured abdominal organ bleeding in to the abdomen. Either abdominal U/S or DPL should be considered in unstable patient, once the ABC's adn fluids are taken care of. CT is indicated in stable patients with suspected solid organ injury
C. AP, lateral and open mouth neck X-Ray and D. CXR ARE indicated, BUT ONLY AFTER DPL. U/S is an alternative to DPL.
so the main point: Whenever a patient is in decompensated hemorrhagic shock most probably from a ruptured abdominal organ bleeding, next step is a DPL or abdominal U/S.
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| Justice
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Yes, this is (B)
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| damngood
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unstable patient with suspected intra abdominal bleeding go for
Dpl /usg
ct scan is a better option for a intra abdominal bleed and the patient is stable
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