major intersection and was hit by a car going approximately 40 mph down the
cross street. On arrival to the ED, HR 160 BP 110/70 RR 26, SpO2 96% RA.
His primary survey was significant for thoraco-abdominal ecchymosis; secondary survey showed a GCS of 11 with agitation. He was endotracheally intubated for declining clinical course and behavior control.
CT of his abdomen shows grade III liver laceration; initial hemoglobin is 9 g/dL. On return from radiology, HR 170 BP 88/60. He is started on a massive transfusion protocol in a 1:1:1 ratio (PRBCs:Plasma:Platelets); after 40 mL/kg of PRBCs, his repeat vital signs show HR 110 BP 100/80 with normal urine output and skin signs.
While awaiting a bed in the intensive care unit, he develops a wide-complex
tachycardia with a palpable peripheral pulse:
A. Perform thoracotomy, cross-clamp aorta, open cardiac massage
B. Membrane-stabilization therapy
C. Re-initiate massive blood transfusion to optimize oxygenation
D. Emergent hemodialysis
In the meantime, a quote –
Every man prefers belief to the exercise of judgment.
– Lucius Annaeus Seneca, Roman Stoic philosopher (4 BC – AD 65)
Experts often possess more data than judgment.
– Colin Powell, retired US Army general (1937 - )