Question

Ms. K.W., is a 21-year-old university coed, was rushed to the emergency room 35 minutes after being stabbed multiple times in the chest and abdomen by unidentified assailant. A witness telephoned 911. Paramedics arriving at the scene found the victim conscious but in severe acute distress. Vital signs were obtained and the results are: HR 128 (baseline 80), BP 80/55 (baseline 115/80), RR 37 and labored. Chest auscultation revealed decreased breath sounds in the right lung consistent with basilar atelectasis (i.e., collapsed lung). PERRLA within normal limits. Her LOC (level of consciousness) was reported as "awake, slightly confused, and c/o severe chest and abdominal pain." K.W. also had absent pedal pulses, weak radial pulses, and palpable carotid pulses. She was immediately started on intravenous Lactated Ringer's solution at a rate of 150 ml/hr. Patient Case Question 1. With two words, identify the specific type of hypovolemic shock in this patient. An EKG monitor placed at the scene of the attack revealed that the patient had developed sinus tachycardia (ST). She was tachpneic, became short of breath with conversation, and reported that her heart was "pounding in her chest." She also appeared to be very anxious and continued c/o pain. Her skin and nail beds were pale but not cyanotic. Skin turgor poor. Peripheral pulses were absent with the exception of a thready brachial pulse. Capillary refill time was approx. 7-8 seconds. Doppler ultrasound had been required to obtain an accurate BP reading. The patient's skin was cool and clammy. There was a significant amount of blood on her dress and on the pavement near where she was lying. Patient Case Question 2. Based on the patient's clinical manifestations, approximately how much of her total blood volume has been lost?

Answer 1

Question 1

Haemorrhagic shock

Ms. KW is in the state of haemorrhagic shock. It is a type of hypovolemic shock. Hypovolemia is a state of decreased blood volume. Hypovolemic shock is also called circulatory shock. It is a life threatening medical emergency characterised by the inability of the circulatory system to supply enough oxygen to meet tissu requirements. Haemorrhagic shock occur due to excessive bleeding or haemorrhage resulting in considerable amount of blood loss.

question 2.

Blood volume lost : Approximately 1.5 liters

Based on her clinical manifestations Ms.KW lost her blood around 1.5 liters. When a person lose their blood 30 - 35% of his total blood, breathing rate will increase( tachypnoea), blood pressure will decrease( hypotension), tachycardia( increase pulse rate) and confusion may occur. ( An adult person may have a blood volume of 4.5- 4.7liters).