zx_stien
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A 21-year-old man is brought by ambulance to the emergency department after being involved in a high-speed collision on his motorcycle. The patient struck a retaining wall at over 100 miles per hour. At the scene, he was non-responsive. He was intubated, a peripheral intravenous was placed, and he was transported to the hospital. On arrival, the patient is non-responsive to command. His temperature is 37.0 C (98.6 F), blood pressure is 60/30 mm Hg, pulse is 140/min, and respirations are 10/min via mechanical ventilator. He has multiple ecchymoses on his abdomen and chest, with an open femur fracture on the right and a depressed skull fracture. His abdomen is distended and tense and a radiograph suggests massive blood in the abdomen from a venous tear. A femoral vein cut-down is performed by the surgical team and a femoral vein central line is placed. After rapid infusion of 6 liters of crystalloid and 4 units of packed red cells via the femoral line, the patient is noted to be in pulseless electrical activity. The most appropriate next step in the management of this patient is to
A. bring the patient emergently to the operating room
B. continue rapid transfusion of blood products and crystalloid via the femoral line
C. give epinephrine, intravenously
D. place an upper extremity intravenous line and infuse volume and blood product
E. perform DC cardioversion at 200 Joules
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| yarab99
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A-?
laprotomy to repair the intraabd tear and control bleeding
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| zx_stien
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| charlottenian
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D....
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| paheli
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C
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| zx_stien
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Paheli
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| docnit
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D
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| docnit
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stabilise the pt then take him to the OR for laparotomy
push more fluids frm upper extremity...PEA is due to severe hypotension
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| zx_stien
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Docnit 
this patient is suffering (Almost ) from IVC rupture, so No matter how much we infuse him thru the femoral vein nothing is gonna be in the circulation nor reach the heart, so before going to the OR, we must eslablish An access to the SVC.. .
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| zx_stien
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so we establish the Upper extrimity line and start to infuse blood products and fluids
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| docnit
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good q!
where do u find soo many good ones? whats ur source?
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| docnit
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just a small tip i have noticed in mcq's.......
usually when they give 2 very similar looking options...........it has to be one of them..
like here option B, D both suggest to push fluids but B makes no sense cos thats alreeday been done so we have to think thats its probably D and then when u think it thr u will realise it makes asolute sense..
justt a small trick....of course mle tries it best to avoid such ones...but just my observation thr several qs..
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| docnit
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u can just use it as a confirmation after thinking thr the q as well....
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| drfax
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The most common cause of PEA is hypovolemia
The first step in management is volume replacement
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| zx_stien
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| yukti_5
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nice Q
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