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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Describe the clinical presentation, including signs, symptoms, and laboratory test measurements for the typical hypovolemic shock patient

  • Prepare a treatment plan with clearly defined outcome criteria for a hypovolemic shock patient that includes both fluid management and pharmacologic therapy

  • Compare and contrast relative advantages and disadvantages of crystalloids, colloids, and blood products in the treatment of hypovolemic shock

  • Formulate a stepwise monitoring strategy for a hypovolemic shock patient

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PATIENT PRESENTATION

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Chief Complaint

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"Some guy shot me in the stomach! It hurts really bad!"

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History of Present Illness

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EM is a 25-year-old male who was at a nightclub and got into an argument with other patrons. During the argument he was shot in the abdomen with a handgun. He was transported to the trauma center by ambulance within approximately 30 minutes of his injury. In the ambulance, he was alert and oriented, and his vital signs were BP 140/95 mm Hg, HR 90, and RR 14. The paramedics reported that the patient had "moderate" blood loss from the bullet entry site. On arrival to the trauma center, he became restless and confused during his interview by the trauma team. His admission BP was 110/70 mm Hg, HR 110, RR 24, and SaO2 85% (0.85) and dropping. Subsequently, he was endotracheally intubated and placed on mechanical ventilation. He had two large-bore venous catheters and a urinary catheter placed.

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Past Medical History

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Noncontributory

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Family History

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Noncontributory

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Social History

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Single, employed at a local factory

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco; (+) marijuana use

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (unknown type)

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Medications (Current)

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Unable to be determined prior to intubation

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Review of Systems

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Before intubation, the patient complained of generalized weakness. His urine output in the catheter collection system was noted to be very dark yellow.

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Physical Examination

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General
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Well-nourished, young, African American male with increasing confusion and restlessness in some distress.

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Vital Signs (10 Minutes after Admission)
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BP 80/45 mm Hg, HR 120, RR 20 (mechanically ventilated), T 36°C

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Weight 198 lb (90 kg)

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Height 70 in. (178 cm)

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Skin
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Cool

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HEENT
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PERRLA, EOMI, otherwise normal; oral endotracheal tube in place

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Neck and Lymph Nodes
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Normal

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Chest
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(+) Breath sounds and clear to auscultation bilaterally

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