Shock

A 42 year old female is transferred from another hospital for chemotherapy. Two days prior to transfer the patient had undergone a laparotomy for a hysterectomy. The procedure was abandoned when the surgeon realized that there was an inoperable tumor present in the pelvis, and there was a considerable amount of blood loss, which continued into the post-operative period.

Hours after transfer the patient becomes initially hypoxemic and subsequently hypotensive. Her temperature is 37 degrees Celsius, her heart rate is 140, blood pressure is 80/36, ECG shows a sinus tachycardia, SpO2 is 79%. The patient’s hemoglobin is 10.2g/l, and creatinine is 1.4.

What is your differential diagnosis, and how would you manage this patient?

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