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unstable pt with low GCS

khumar huseynova khumarhuse at yahoo.ca
Sun Dec 7 20:31:27 GMT 2008 

47M post-MVA, comes in with GCS=8-9 which drops to 5, SBP in the low 80's, HR=129-135. Intubated, primary survey reveals, reduced L breath sounds, distended abdo and unstable pelvis. FAST pos, CXR shows widened mediastinum w NG in the L thorax, pelvic XR-open book fracture. Sheet around the pelvis, L CT inserted, fluids given, pts BP slowly comes back up to 100-110 but still labile with fast HR. Everything is done within minutes. What would be your FIRST step:
1.Do CT head since pt is responding to ivf (albeit partially) which means there is still time to r/o intracranial bleed/SAH etc pre-op
2. Angio given pt's open book fracture, which is likely the source of intraabdo/pelvic bleed and hypotension
3. Direct to OR; deal with CT head and angio afterwards.
 
Thanks. K


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