Case 3-1: A 31-year-old man arrived by ambulance at the emergency department aft

Question

Case 3-1: A 31-year-old man arrived by ambulance at the emergency department after suffering a laceration to the left thigh in an industrial accident. The patient was working in a metal fabrication plant. A falling piece of steel lacerated a vessel in his left thigh, causing the loss of 1.5 L of blood, an estimated 30% of his blood volume. Bleeding was controlled by direct pressure, and the patient received 2 L of 0.9% saline during transport. The patient was pale, diaphoretic, and anxious. He was transferred to the trauma room, where arterial, pulmonary artery (Swan-Ganz), and bladder catheters were inserted. A pulse oximeter was place on the fourth finger of his left hand.

Physical examination:

Vital Signs     Temp: 35.5 degrees Celsius

                        Pulse: 120/min, weak

                        Respiratory rate: 22/min, shallow

                        BP: 80/60 mm Hg

                        BMI: 25

                        Oxygen saturation by pulse oximetry: 92%

How does 0.9% saline solution compare to the NaCl concentration of body fluids?

A solution of 0.9% sodium chloride is simply salt water, and contains only water, sodium (154 mEq/L), and chloride (154 mEq/L). Although the mEqs/L are different than plasma concentrations, it's often called "normal saline solution" because the tonicity is similar to plasma tonicity.

Therefore....0.9% sodium chloride is used during resuscitation and the only solution that may be administered with blood products.

What is meant by the patient being “diaphoretic”?

Diaphoretic refers to the medical term, diaphoresis, it is used to describe the excessive, abnormal sweating due to surroundings and the activity level.

Diaphoresis is the medical term used to describe excessive, abnormal sweating in relation to your environment and activity level. It tends to affect your entire body rather than a part of your body. This condition is also sometimes called secondary hyperhidrosis.

Hyperhidrosis, or primary hyperhidrosis, is also associated with profuse sweating, though it’s thought to be a nervous system disorder. With primary hyperhidrosis, sweating is normally limited to select parts of the body, such as your hands or feet.

Diaphoresis is usually a symptom of an underlying health condition. Some conditions can be life-threatening and require immediate medical attention. It can also be caused by certain medications.

What values does an arterial catheter provide?

What values does a pulmonary artery (Swan-Ganz) catheter provide?

Why was a urinary bladder catheter inserted?

What tests or studies would you order?

Explanation / Answer

Case 3-1: A 31-year-old man arrived by ambulance at the emergency department aft

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