cause of hypotension

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Severe traumatic brain injury can act this way. The patients initial
shock presentation can also account for the pupillary findings. 


Patrick J. Offner MD MPH
Chief, Surgical Critical Care
St Anthony Central Hospital

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Anthony Caruso
Sent: Sunday, February 24, 2008 7:12 AM
To: Trauma & Critical Care mailing list
Subject: RE: cause of hypotension


Dr. My 1st guess would be that he suffered some type of spinal cord
trauma.  The brain signals were blocked because of some type of cord
compromise. Causing the peripheral vasculature to vasodialate.  Usually,
these patients wouldn't be unresponsive, however he may have suffered
some type of brain trauma concurrently post MVC.  Although, his heart
rate was elevated.  What was he doing prior to the crash? (I.E. poly
substance abuse of some sort) Which may explain the pupils being
dilated. Definitely an interesting case.  Keep us informed as to what
the results were post mortem.  Anyone else care to add, please do so.
Ron, Pret, Tim?  
 
 Anthony Caruso. EMT-P> Date: Sun, 24 Feb 2008 05:25:59 -0800> From:
asifhansari at yahoo.com> To: trauma-list at trauma.org> Subject: cause of
hypotension> > SUB: Cause of hypotension in MVA patient.> > Hellow,> > i
am a Gen.Surg resident and in 2 years of i have seen 2 pts coming to
trauma, in shock,25yr male,Unconscious(intubated),BP not
recordable,peripheral pulse absent, Pupils B/L dilated and
fixed,chest-B/L breath sound +,CVS-audible heart sounds. Abdomen
Soft/lax/Bowel sound+> aftr resuusitation with 2 Lit RL and 2 U PRBC, BP
came to 110/70,pulse110> CXR no pneumo/hemo> Pelvic xray-no #> USG
abdomen- no free fluid> we decide to shift the pt to CT with the above
vitals-as the pt is shifted to CT table, pt. arrest , CPR done 40mins >
but pt declared dead.> > my question here is, what could be cause of
shock if we excluded hemorhage, as there was no bleeding in the
chest/abdomen/> pelvic/no long bone fractures.> > the only thing was the
pupils B/L Dilated and fixed !> now is there any cause in the Head which
can cause this?> i mean after excluding Hemorrhagic cause, if we label
Neurogenic shock, the pt should be Hypertensive and Bradycardic.> please
give your expert opinions.> Thanks> > Dr.Asif.H.Ansari;MBBS, MRCS (Std)>
King Khalid Hospital> Saudi Arabia> > >
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