A 33 y.o. male comes to the ER via ambulance after having sustained a very large

ID: 3476964 • Letter: A

Question

laceration to his right leg (thigh) at work. It appears that the femoral artery has been cut.

A piece of steel caused the deep cut. The patient appears to have lost over a liter of

blood. Direct pressure has been applied. So far the patient has received nearly 2.0 Liters

of saline while in the ambulance.

The physical examination reveals the following:

Vital Signs:

Temperature is 35.6 degrees C

Pulse is 122 bpm and is very weak

Respiration is 21 breaths per minute and is somewhat shallow

Blood pressure is 82/64 mmHg

Physical Exam:

Height is 68.5 inches

Weight is 160 lbs

Overall the patient is diaphoretic, pale looking, and is very anxious. The patient was

immediately transferred to the trauma room, and a Swan-Ganz catheter was placed, an

arterial catheter was placed, and a bladder catheter was placed. A pulse oximeter was

also placed on his finger.

Lab studies reveal:

Pulse ox is 91%

Arterial blood gases are PO2 is 91 mmHG, PCO2 is 46 mmHg, and pH is 7.31

Cardiac output is 3.0 L/min

Hematocrit is 36%

Plasma protein concentration is 5 g per dL

There is very little urine production.

Questions:

What is the diagnosis?

Describe the pathophysiology of the key symptoms / lab values / vital signs.

What hormonal changes would you expect in this situation?

What are the mechanisms contributing to these hormonal changes?

How would you treat this patient?

The diagnosis is Hypovolemic shock due to blood loss.

Pathophysiology of this condition is

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