A 53-year female who presents to the emergency room 35 minutes after sustaining multiple stab wounds to the chest and abdomen during a fight with her ex-boyfriend. Upon initial assessment
A 53-year female who presents to the emergency room 35 minutes after sustaining multiple stab wounds to the chest and abdomen during a fight with her ex-boyfriend. Upon initial assessment vital signs heart rate: 128 irregular BP was 80 / 50 respiration rate 37 and labored. Chest auscultation reveals decreased breath sounds in the right lung consistent with bibasilar atelectasis. Pupils were equal round and reactive to light and accommodation. Her level of consciousness is awake but slightly confused and complaining of severe abdominal and chest pain. Pedal pulses are absent, radial pulses are weak in carotid pulses are palpable. The patient is immediately started on intravenous lactated Ringer’s solution at a rate of 150 ml/hr.
She becomes tachypneic, short of breath and reports her “heart was pounding in her chest”. She becomes very anxious and continues to complain of pain in the chest and abdomen. Skin and nail beds are pale, no cyanosis, skin cool and clammy with poor turgor, peripheral pulses become absent except for a thready brachial pulse. Blood pressure becomes difficult to assess and doppler ultrasound is used to obtain a bp of 75/50, HR 38 Sinus Rhythm.
Labs:
Hb 8g/dl
Hct 25
PaO2 53 mm hg
PaCo2 52 mm HG
pH 7.31
SaO2 84% on RA
Please answer these questions before continuing:
What is your initial differential diagnosis?
Is there any other subjective or objective data you would want to collect?
Is it necessary that sodium bicarbonate be administered to the patient at this time? Explain your rationale
Should this patient be transfused with whole blood, and if so, how many units?
New Labs:
Pt is started on Oxygen at 3 l/min by nasal cannula. Repeat blood gas shows; PaO2 82 mm Hg, PaCO2 38 mm Hg, pH 7.36, SaO2 95%.
Please answer these questions before continuing:
Are the arterial blood gas results improved or deteriorated?
What are your next steps?
Second Labs:
After your resuscitation, lab values are:
Na 135 meq/L
K 3.8 meq/L
Cl 110 meq/L
HCO3 28 mg/dL
BUN 38 mg/dl
Cr 2.0 mg/dL
Glu, random 168 mg/dL
PT 13.4 sec
PTT 32 sec
Ca 8.0 mg/dL
Plt 181,000. Mm
WBC 7,200 /mm
Please answer these questions:
Explain why the BUN and Cr are abnormal.
Explain the abnormal serum glucose concentration
Are there any concerns for a blood clotting problem?
Please attach your reference list here.
References:
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