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Mon Dec 8 12:36:56 GMT 2008

OR first, fix what is bleeding, and pack pelvis (and abdomen, if needed). Angio of the pelvis immediately post-op.  CT head once patient is "stable".  If you don't take care of surgical bleeding, and restore SBP to >100, then it really doesn't matter what the head CT would have shown - you have allowed for the second hit to the already injured brain.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
Sent: Sunday, December 07, 2008 3:31 PM
To: Trauma Trauma
Subject: unstable pt with low GCS

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