unstable pt with low GCS

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I'd say straight to OR. They'll go off in scan (donut of death)!!!


On 7 Dec 2008, at 20:31, khumar huseynova wrote:

> 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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