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Sun Dec 7 21:15:52 GMT 2008

Off to OR.
ICP monitor placed while in OR.
Pelvis immobilized with external device (sheet often does wonders).
Damage control the abdomen.
Warm them, correct coags and acidosis.
Off to CT and possible angio

Andrew

On Sun, Dec 7, 2008 at 4:09 PM, Lorraine Smith <drlorraine.smith at sky.com>wrote:

> 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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unstable pt with low GCS