Trauma Surgery: Day 17

Was in from 6a-545p. It took us about 7 hours to round with the attending, which is a new record! We started, as we always do, with our sickest patients first. Got through with the SICU patients and moved quickly upstairs to the MICU to work with our motorcycle injured patient. The blood pressure kept dropping despite our best efforts: we gave full doses of 2 vasopressors, increased his blood volume by increasing the saline drip and fluids, and decreased the diuretics. There are 5 main causes of shock: Cardiogenic (associated with heart problems, like an MI, Cardiac Tamponade, Cardiac Contusions); Hypovolemic (associated with low blood volume, like loss of a lot of blood, dehydration); Anaphylactic (associated with response to an allergen); Septic (associated with infections and immune response); Neurogenic (associated with injury to the brain or spinal cord). This patient was clearly in some form of shock, since the blood pressure was low AND his heart rate was low. Normally, when our blood pressure drops, such as when we stand up from laying down & our blood rushes to our legs, our heart rate will increase to compensate. So normally, a low blood pressure and increased heart rate go together, and high blood pressure and low heart rate go together in response to a change in our set values. This patient was experiencing low blood pressure and low heart rate. So the question was: what type of shock is going on, and how can we treat it? We gave vasopressurs (addresses cardiogenic shock: we wanted to increase the blood pressure to counteract the slow heart rate), we increased the volume repletion and gave blood (addresses the hypovolemia), there were no allergic reactions suspected (no need to address anaphylactic); we gave diuretics and watched the sodium and electrolytes carefully (to support the patient's healing process of the brain and spinal cord). In essence, we were doing about everything we can to support the patient. We ended up giving some more blood, as there was a lot of blood loss previously, in an attempt to address hypovolemia. The patient's stats improved. We are hoping for enough improvement to be able to be stable enough to get a CT scan, so we can see what's going on in the brain. The patient is heavily sedated to keep his intracranial pressure down (which helps to support the patient's ability to heal the brain), so we can't do very accurate neurological exams. A CT would help us to better see what is going on. The overall prognosis can't be determined at this point, we need a CT scan to be able to better assess the long-term outcomes.

After work, Mike & I (and Marley) went straight to a soccer game...I kind of watched him play, but I also read/studied for about an hour. I have got a whole lot to learn before my shelf exam on September 9th. It seems like a long time from now, but I know it will sneak up on me and before I know it, I won't have enough time to cram in all of the information I'll need for my exam. This stuff sure is a lot of work!!! but TOTALLY worth it! :) :) :)