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A trauma mystery

Varcelotti MD, Jorge trauma-list@trauma.org
Tue, 29 Apr 2003 06:54:44 -0400

Probably causes of the instability...spinal cord injury?...cardiac injury?.
Were those injuries r/o?

> -----Original Message-----
> From:	yoram klein [SMTP:yklein_2000@yahoo.com]
> Sent:	Tuesday, April 29, 2003 3:45 AM
> To:	trauma-list@trauma.org
> Subject:	A trauma mystery
> A case from last night. 
>  A 48 year old truck driver, rolled over with his full
> trailer.   In the resuscitation bay he was alert
> complaining of chest pain, sO2=89% with face mask,
> heart rate= 150, systolic BP of around 70, base
> deficit of -11, no neurologic compromise. CXR showed
> right lung contusion and widened mediastinum. Normal
> pelvic X-ray. FAST is negative. multiple ribs
> fractures on the right. Despite continued fluid and
> blood resuscitation, he remained hemodynamic unstable.
> Intubated, Right chest tube = minimal amount of blood.
> TEE = normal aorta, under filled heart, no pericardial
> fluid. DPL = negative. Hemoglobin dropped from 13 on
> admission to 12 an hour later. Chest CT = severe right
> lung contusion, small retrosternal anterior
> mediastinal  hematoma. Abdominal CT =  normal. In the
> ICU the patient remained unstable, with no significant
> drop in hemoglobin. A PA catheter is inserted and
> there is a clear hypovolemic profile. During the night
> the patient gradually got  better with no specific
> treatment except for fluid. In the morning he is
> hemodynamic normal , and even his oxygenation
> improved. Any ideas about the source of his resolved
> shock? 
> Yoram
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