Surgery Rotation

[Junito]

A 17 yo male presents to the ER who was in a serious MVA. He is shivering, has a bp of 70/50, has tachycardia, and is asking for some water to drink. He is breathing well and does not have distention of the neck veins. What do you suspect this patient is suffering from? How would you manage the patient?

[njmd123]

I would suspect that if after physical exam..with no noticable deformity or or injury...if ct and xray are clear that he is just in shock...I would watch for 24 hrs... but I'm not a dr..what do I know..

[TropicMD]

Hmmmmm....I am thinking shock, possibly internal hemorrhage since this is a surgery question and the patient suffered trauma. But, you didn't mention if he had abdominal bruising, guarding, rigidity, etc...

I would get two large bore IVs placed immediately with fluid bolus. Imaging. Keep him warm and NPO. Monitor vitals and ECG. Consider exp. Lap pending imaging results.

[Jeep23Guy]

Maybe hypovolemic shock? Guy could have aortic rupture or cardiac tamponade I guess.

[Junito]

Hmmmmm....I am thinking shock, possibly internal hemorrhage since this is a surgery question and the patient suffered trauma. But, you didn't mention if he had abdominal bruising, guarding, rigidity, etc...

I would get two large bore IVs placed immediately with fluid bolus. Imaging. Keep him warm and NPO. Monitor vitals and ECG. Consider exp. Lap pending imaging results.

I would get two large bore IVs placed immediately with fluid bolus. Imaging. Keep him warm and NPO. Monitor vitals and ECG. Consider exp. Lap pending imaging results.[/quote]

Very good. I was indeed hinting at internal hemorrhage. No difficulting in breathing rules out a pneumo-thorax, and his neck veins were not distended, and therefore eliminates tamponade. His abdominal area was injured, not his chest, so internal hemorrhage of the abdominal area is most likely.

[microphage]

almost all trauma qs in kaplan qbank answers are ex-lap. i wish i could say the same for the shelf exam.. ugh