Hematology Case #1 A twenty-eight year old male was involved in a motor vehicle

Question

Hematology Case #1 A twenty-eight year old male was involved in a motor vehicle accident; his motoreycle hit a median divider, and he was brought to the ER. Initial laboratory values are within normal limits. CT scan shows no evidence of liver or spleen laceration. One liter of Ringer's lactate is infused along with two (2) units of blood. While in route back to the ER from the x-ray facility, the patient complains of chills, chest pain, and flank pain. Vital signs are significant for hypotension and tachycardia. Blood work is significant for anemia. . What is the most likely cause for his hypotension and tachycardia? What is the best course of action for this patient? . Case #2 A patient is scheduled for elective surgery. The patient is currently taking 325 mg of enteric-coated aspirin What do you tell the patient? What is the mechanism of action for aspirin? List the potential side effects from this medication.

Explanation / Answer

Case 1:

The patient may have suffered pelvic injury. Hypotension & anemia also signifies significant blood loss. Due to pelvic injury the patient has suffered intra-abdominal blood loss which resulted in hypotension & tachycardia.

First we need to stabilize the patient by maintaining his vitals. The blood should be given with vasopressor agents to reduce his blood pressure & hestar IV fluid should be given to prevent the shock from this trauma.

Case 2:

Aspirin has anticoagulant effects, i.e., it inhibits clotting of blood. So, we should tell the patient that he should stop taking aspirin prior to 10 days of surgery.

In the vascular endothelial cells aspirin inhibits the synthesis of cyclooxygenase; which resulted in inhibition of prostacyclin production & platelet aggregation.

Side effects of aspirin include nausea, vomiting, stomach pain, fever, gastrointestinal bleeding, allergic reaction etc.

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