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Case
#53 "Doc, Am I Gonna Die?"
by Charlene Babcock Irvin, MD
 A
28 y/o male presents by personal car with
complaints of GSW to the back. As I walk
into the resuscitation room, the nurse is
hooking him up to the monitor, he is awake,
talking to the nurse, and has no obvious
bleeding sites identified.
As I approached the bed I ordered: “IV (2 lg
bore, normal saline), oxygen (100% NRB),
monitor, undress the patient, get me a set
of vital signs, and draw blood for ‘trauma
labs’ including type and cross.”
He looks over to me and asks: “Doc, am I
gonna die?”
I reassure him that we are going to take
great care of him, and he is exactly where
he needs to be.
His airway is open; he has equal breath
sounds without any crepitus and equal chest
excursion. Is abdomen is rigid and tender.
His pelvis is stable and non-tender. His
thighs ware without abnormalities, and he
can hold both arms up with good grasp, but
when lifting his legs, he cannot sustain his
left leg against gravity. Pulses present in
all four limbs. Log roll reveals a single
GSW to the left of L3 with tenderness to L2
and L3 on palpation. No significant bleeding
is noted. Normal rectal tone without obvious
blood.
1. What is permissive hypotension?
2. How can you ‘guess’ the blood pressure
using pulses?
3. What is a quick way to assess the ABC’s?
4. When should you start FFP in trauma
patients getting blood transfusions?
5. Does he need a FAST exam?
Click here for answers and to respond
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