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
"Some guy shot me in the stomach! It hurts really bad!"
History of Present Illness
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.
Single, employed at a local factory
Social drinker; (−) tobacco; (+) marijuana use
Allergies/Intolerances/Adverse Drug Events
Penicillin (unknown type)
Unable to be determined prior to intubation
Before intubation, the patient complained of generalized weakness. His urine output in the catheter collection system was noted to be very dark yellow.
Well-nourished, young, African American male with increasing confusion and restlessness in some distress.
Vital Signs (10 Minutes after Admission)
BP 80/45 mm Hg, HR 120, RR 20 (mechanically ventilated), T 36°C
PERRLA, EOMI, otherwise normal; oral endotracheal tube in place
(+) Breath sounds and clear to auscultation bilaterally