Question

J. S. is 23 years old. He was brought to the emergency department after an auto accident. He suffered a concussion and a deep laceration of his right thigh. He lost about 4 units of blood prior to effective control of bleeding and closure of the wound. Fluid resuscitation is initiated, and a urinary catheter is inserted post operation to monitor his urine output. However, he continues to have significant oozing from his sutured wound.

His 24-hour urine volume is 350 ml with a high urine osmolality and low urine sodium. A coagulation screen results indicate the following: platelet count 250,000, bleeding time and a PTT time are both extended.

1. If J. S. does not receive adequate treatment, what further condition may he develop? Why? What is the best treatment option to prevent this from occurring?

Answer 1

If significant oozing of blood continues, it will lead to SHOCK primarily hypovolemic shock and if not treated then surely decompensated hypovolemic shock and may lead to death.

As because blood decreses- body fluid decreases-venous return to the heart decreases-cardiac output decrease--hypoxia-hypoperfusion and tissue hypoxia and ultimately to multi organ failure.

PREVENTION---- by giving massive blood transfusion which is replacing entire volume in 24 hours or more than 10 units in 24 hours. AND ALSO MONITOR Respiratory rate, BP, PLUSE, URINE OUPUT ,SHOCK INDEX,MODIFIED SHOCK INDEX ETC.

Blood substitute can be perfluorocarbon,Stroma free hb,polyethylene glycol hb.