This patient with anemia and extreme hypotension following MVA is bleeding into her pelvis/thighs. She urgently needs isotonic fluids and blood products prior to further workup.
Young patient involved in a motor vehicle accident who initially developed thigh pain and now has impaired consciousness with signs of hemodynamic instability most consistent with traumatic bleeding into the thighs, leading to hypovolemia
Key idea: Hematocrit can be normal during acute hemorrhage due to loss of equal parts of red cells and plasma, and may not drop until patient has received volume resuscitation
Key idea: Potential sites of bleeding in setting of traumatic hemorrhagic shock that can accommodate lots of bleeding are โBlood on the floor and 4 moreโ: (1) Floor (obvious external bleeding) (2) Chest (3) Abdomen (4) Pelvis (5) Thigh
drdoomsystolic registered @ 40 by cuff but diastolic too low to be detected; โpalpableโ as in a pulse is palpable (but diastolic too low for detection)+4
submitted by โmedicalmike(82)
This patient with anemia and extreme hypotension following MVA is bleeding into her pelvis/thighs. She urgently needs isotonic fluids and blood products prior to further workup.