History: This injury occurred in an otherwise healthy 31 year old male who was working in an awkward position and fell o
Posted: Mon May 02, 2022 8:40 pm
History: This injury occurred in an otherwise healthy 31 year old male who was working in an awkward position and fell off the roof sliding over a substantial area of sharp partially constructed materials. This fall was located at a job site that was up in the “mountains” at a retreat home being built by a corporate individual and was in a hard to access region. Fellow workers reported that it did not appear that this individual hit his head and he was wearing a helmet at the time. He hit the ground feet first and collapsed to the ground shortly after (reports indicate within 5 seconds). The worker was awake and cognizant when his other coworkers including the foreman arrived within a minute of the accident. The individual had numerous “cuts and scrapes” over his exposed regions and workers also noticed that there was a lot of blood associated with his right arm and chest. This volume of blood seemed to be increasing steadily as they attended to him. Upon further exam, it appeared that he had an injury to his right arm in the armpit area and the majority of bleeding was originating from here. Workers (several of which had first aid or EMT training) applied both a pressure bandage and a makeshift tourniquet to the upper arm/shoulder region with moderate success. A satellite cell phone call was made to 911 and a helicopter located and evacuated the man within 20 or 25 minutes of the accident.
The paramedics placed two large-bore catheters and began infusing physiologic saline intravenously. During transport, the patient became increasingly disoriented. The helicopter trip to the hospital took approximately 10 minutes.
There are no known allergies, or other health risks known about this individual and he was in good health according to his coworkers. The health workers attempted to contact the injured party’s family, but they lived in a different region of the country and could not be reached.
Physical Exam: The patient was very lethargic upon admission, but was responsive to loud stimuli. Multiple abrasions and contusions were noted on the face, anterior thorax and abdomen. Examination also noted a deep, 10cm laceration in the right axillary region. The clothing and improvised tourniquet in this region were heavily soiled with blood.
Facts/Vitals:
Height 5’11”
Weight 185#
HR (supine) 118 bpm (sitting) 141 bpm
BP (supine) 104/61 (sitting) 87/55
RR 35 bpm
Temp (per rectum) 37.2°C
Skin felt cool to the touch and was also clammy
Pulses were assessed at multiple sites and all were weak and thready
Cranial nerve assessment was normal
Pupil size and reactivity to light stimuli fell within the normal range
Heart auscultation revealed tachycardia, normal rhythm with no detectable murmurs
Lungs auscultation and percussion were normal
Abdominal guarding was noted, but gentle palpation could detect no abnormal masses
Blood was drawn. Blood work was preformed including a CBC and chemistry screen. The patient’s blood was also typed. A urinary catheter was placed via the urethra and another IV catheter was placed in the left subclavian vein and a pressure transducer was threaded into the superior vena cava so the central venous pressure could be monitored. A cardiovascular surgeon was also notified for the potential of immediate surgery.
Lab Work
WBC Count 8200 WBC’s/mm3
Differential was 65% neutrophils
Hematocrit was 49%
Hemoglobin 15.1 gm/dl
Sodium 137 mEq/L
Potassium 5.2 mEq/L
Chloride 101 mEq/L
BUN 35 mg/dl
Creatinine 2.5 mg/dl
Glucose 185 mg/dl
SGPT 55 IU/L
SGOT 47 IU/L
Blood pH 7.27
pCO2 31 mm Hg
pO2 79 mm Hg
Hemoglobin O2 saturation 86%
HCO3- 13.3 mEq/L
Urinary output over the initial 1 hour after catheter placement was 20 ml of dark yellow urine. It had a specific gravity of 1.030
Central Venous Pressure varied between 1 and 3 cm of H2O during an average cardiac cycle
EKG had a normal sinus rhythm although it was noted that there was a slight ST depression.
A blood transfusion was performed on this patient once the blood was typed and matched. The patient survived with no long lasting consequences.
Question 5: What about the SGOT and SGPT? Are there other terms for SGOT and SGPT? Same questions as #4.
Question 6: Why is CVP decreased and how can it be resolved?
Question 7: Upon arrival at the hospital, the patient was lethargic and seemed to lack orientation. Why?
Question 8: The EKG exhibited some ST segment depression. What is that and why has it occurred in this individual?
Question 9: What is the acid-base status of this patient? What term would we apply to describe it and why? How would it best be corrected or is it even important to try and resolve it?
Question 10: The PCV in this patient is normal. Would not you have expected it to be different considering what this patient has undergone? And since the patient’s PCV is normal, why were they given a blood transfusion? (2 units – by the way, what is a unit)?
Question 11: There was some discussion about obtaining an abdominal and or thoracic MRI, but they did not do so. Under what conditions in this patient might have they gone ahead with it?
The paramedics placed two large-bore catheters and began infusing physiologic saline intravenously. During transport, the patient became increasingly disoriented. The helicopter trip to the hospital took approximately 10 minutes.
There are no known allergies, or other health risks known about this individual and he was in good health according to his coworkers. The health workers attempted to contact the injured party’s family, but they lived in a different region of the country and could not be reached.
Physical Exam: The patient was very lethargic upon admission, but was responsive to loud stimuli. Multiple abrasions and contusions were noted on the face, anterior thorax and abdomen. Examination also noted a deep, 10cm laceration in the right axillary region. The clothing and improvised tourniquet in this region were heavily soiled with blood.
Facts/Vitals:
Height 5’11”
Weight 185#
HR (supine) 118 bpm (sitting) 141 bpm
BP (supine) 104/61 (sitting) 87/55
RR 35 bpm
Temp (per rectum) 37.2°C
Skin felt cool to the touch and was also clammy
Pulses were assessed at multiple sites and all were weak and thready
Cranial nerve assessment was normal
Pupil size and reactivity to light stimuli fell within the normal range
Heart auscultation revealed tachycardia, normal rhythm with no detectable murmurs
Lungs auscultation and percussion were normal
Abdominal guarding was noted, but gentle palpation could detect no abnormal masses
Blood was drawn. Blood work was preformed including a CBC and chemistry screen. The patient’s blood was also typed. A urinary catheter was placed via the urethra and another IV catheter was placed in the left subclavian vein and a pressure transducer was threaded into the superior vena cava so the central venous pressure could be monitored. A cardiovascular surgeon was also notified for the potential of immediate surgery.
Lab Work
WBC Count 8200 WBC’s/mm3
Differential was 65% neutrophils
Hematocrit was 49%
Hemoglobin 15.1 gm/dl
Sodium 137 mEq/L
Potassium 5.2 mEq/L
Chloride 101 mEq/L
BUN 35 mg/dl
Creatinine 2.5 mg/dl
Glucose 185 mg/dl
SGPT 55 IU/L
SGOT 47 IU/L
Blood pH 7.27
pCO2 31 mm Hg
pO2 79 mm Hg
Hemoglobin O2 saturation 86%
HCO3- 13.3 mEq/L
Urinary output over the initial 1 hour after catheter placement was 20 ml of dark yellow urine. It had a specific gravity of 1.030
Central Venous Pressure varied between 1 and 3 cm of H2O during an average cardiac cycle
EKG had a normal sinus rhythm although it was noted that there was a slight ST depression.
A blood transfusion was performed on this patient once the blood was typed and matched. The patient survived with no long lasting consequences.
Question 5: What about the SGOT and SGPT? Are there other terms for SGOT and SGPT? Same questions as #4.
Question 6: Why is CVP decreased and how can it be resolved?
Question 7: Upon arrival at the hospital, the patient was lethargic and seemed to lack orientation. Why?
Question 8: The EKG exhibited some ST segment depression. What is that and why has it occurred in this individual?
Question 9: What is the acid-base status of this patient? What term would we apply to describe it and why? How would it best be corrected or is it even important to try and resolve it?
Question 10: The PCV in this patient is normal. Would not you have expected it to be different considering what this patient has undergone? And since the patient’s PCV is normal, why were they given a blood transfusion? (2 units – by the way, what is a unit)?
Question 11: There was some discussion about obtaining an abdominal and or thoracic MRI, but they did not do so. Under what conditions in this patient might have they gone ahead with it?