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A trauma mystery

Avi Roy Shapira trauma-list@trauma.org
Wed, 30 Apr 2003 15:37:19 +0300 (IDT)

Sounds like Rt ventricle contusion with isolated right heart failure.
The PAC would show a low wedge pressure, but the CVP would be high. 

(I suspect it was, or they wouldn't have inserted the PAC)


On Tue, 29 Apr 2003, yoram klein wrote:

> 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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Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390