Thread subject: NEPI :: Interesting case

Posted by maroju on 12-01-2011 12:06

Going by the given ABCs, I guess he is maintaining his airway. However, there may be an impending airway problem if the clinical shock worsens (also for predicted clinical course).
Sats are poor presumably due to shock. Though there are no added lung sounds, could there be some consolidation or pathology causing respiratory sepsis? What was his temperature and RR?
I presume the ABG was taken with the patient on room air. Lactate is high but bicarb is still reasonable. Looks like the patient is tachypnoeic trying to compensate for the impending metabolic acidosis.
What was the differential BP (between the two sides)? Was there a radio-femoral delay? Any positive findings on FAST/Echo? I guess it should be a case for cautious fluid resuscitation without pushing the BP too high. Might be a good idea to have blood products ready. Was he dissecting? Any mediastinal pathology?
Was he intubated in ED prior to CT/Operation?
How long was he in ED prior to him getting definitive management?