Coda Change Massive Haemorrhage
Sep 12, 2020
A shocking case of a polytrauma patient challenges the resuscitation team when a CT scan reveals no active bleeding despite severe shock. They delve into alternative causes of hypotension, like traumatic brain injuries and cardiac contusions. The discussion highlights the importance of thorough clinical assessments over reliance on imaging. Non-traumatic conditions and iatrogenic issues also come into play, emphasizing the need for a meticulous approach in trauma care.
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High-Stakes Trauma Reception
- The speaker describes receiving a severely shocked 25-year-old polytrauma patient and activating massive hemorrhage protocols while preparing CT and operative teams.
- Despite rapid blood product delivery and resuscitation, the team proceeded to whole-body CT to locate non-compressible bleeding.
CT Shows No Bleeding Despite Shock
- The CT scan returned with no active bleeding yet the patient remained profoundly hypotensive despite multiple units of blood.
- The team were surprised and paused as blood bank asked whether to send the next pack and the haemoglobin measured 168.
Don't Let CT Define The Diagnosis
- Our default assumption in hypotensive blunt trauma is major hemorrhage needing surgery or angioembolisation.
- But some physiological derangements after trauma won't show as anatomical injuries on CT and demand a broader differential.