20-years old man fell off his roof while working there. EMT personal arriving to

Question

20-years old man fell off his roof while working there. EMT personal arriving to the scene observe the following: abdominal pain in R upper quadrant; cyanotic, cool, clammy skin; falling blood pressure 100/60 mm Hg; rapid pulse – 100 b/min. Paramedics did IV with normal saline and transport him to the nearest hospital. His blood pressure continues to decrease and cyanosis became worst. Doctor on call infuse him with (-) 0 pack of RBC’s and transport him to the trauma center. At his admission there the following notes were added to his chart:

·        Abdomen firm and distended

·        Blood drawing for typing and cross matching; pack (+) A blood cells were infused

·        Emergency FAST ultrasound was positive for intraperitoneal fluid

·        Test found intra-abdominal bleeding. He was prepared for surgery – lacerated liver found and fixed. His condition became stabile.

Questions:

1.   Why infusing him with normal saline (because of blood loss) would help?

2.   Why the patient was given RBC’s in addition to the normal saline? What problem this infusion does address that the saline could not? Explain.

3.   Why was the physician able to infuse (-) O blood before the results of the blood test were obtained?

4.   Results indicates that he has a A (+) group. Which type of blood he can receive?

Explanation / Answer

1. Normal saline is infused to rehydrate the patient as it contains water and electrolytes. It is given to prevent dehydration, hypovolemia and circulatory shock. It also helps in expanding blood volume.

Note: Normal saline is a isotonic solution (it have equal concentration of solutes and water)

2. Patient was given RBC in addition to the normal saline to replace the blood loss because of fall and intra abdominal bleeding. And to reduce the symptoms of cyanosis and further complications like shock.

3. Physician was able to infuse O negative because o negative is universal donor blood group. It can be given to anyone because they don't have any antigens on its RBC surface.

4. Blood groups which patient can recieve is A+,O+,A negative, and O negative

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